Association of body size with outcomes among patients beginning dialysis.
ABSTRACT Although obesity confers an increased risk of mortality in the general population, observational reports on the dialysis population have suggested that obesity is associated with improved survival. These reports have generally not examined extremely high values of body mass index (BMI; in kg/m(2)), survival >1 y, or alternative measures of adiposity.
We sought to clarify the relation between body size and outcomes among a large cohort of patients beginning dialysis.
Data on 418 055 patients beginning dialysis between 1 April 1995 and 1 November 2000 were analyzed by using US Renal Data System data. BMI was divided into 8 categories in increments of 3 units, ranging from < 19 to > or =37, and the relation between survival and BMI was examined by using proportional hazards regression with adjustment for demographic, laboratory, and comorbidity data.
High BMI was associated with increased survival in this cohort, even at extremely high BMI, after adjustment, and over a 2-y average follow-up time. This was true for whites, African Americans, and Hispanics but not for Asians. High BMI was also associated with a reduced risk of hospitalization and a lower rate of mortality in all mortality categories. Alternative estimates of adiposity, including the Benn index and estimated fat mass, yielded similar results, and adjustments for lean body mass did not substantially alter the findings.
High BMI is not associated with increased mortality among patients beginning dialysis. This finding does not appear to be a function of lean body mass and, although modified by certain patient characteristics, it is a robust finding.
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ABSTRACT: To study the body mass index (BMI) trajectory in patients with incident end-stage kidney disease and its association with all-cause mortality. This longitudinal cohort study included 17022 adult patients commencing hemodialysis [HD] (n = 10860) or peritoneal dialysis [PD] (n = 6162) between 2001 and 2008 and had ≥6-month follow-up and ≥2 weight measurements, using the Australia and New Zealand Dialysis and Transplant Registry data. The association of time-varying BMI with all-cause mortality was explored using multivariate Cox regression models. The median follow-up was 2.3 years. There was a non-linear change in the mean BMI (kg/m2) over time, with an initial decrease from 27.6 (95% confidence interval [CI]: 27.5, 27.7) to 26.7 (95% CI: 26.6, 26.9) at 3-month, followed by increments to 27.1 (95% CI: 27, 27.2) at 1-year and 27.2 (95% CI: 26.8, 27.1) at 3-year, and a gradual decrease subsequently. The BMI trajectory was significantly lower in HD patients who died than those who survived, although this pattern was not observed in PD patients. Compared to the reference time-varying BMI category of 25.1-28 kg/m2, the mortality risks of both HD and PD patients were greater in all categories of time-varying BMI <25 kg/m2. The mortality risks were significantly lower in all categories of time-varying BMI >28.1 kg/m2 among HD patients, but only in the category 28.1-31 kg/m2 among PD patients. BMI changed over time in a non-linear fashion in incident dialysis patients. Time-varying measures of BMI were significantly associated with mortality risk in both HD and PD patients.PLoS ONE 12/2014; 9(12):e114897. · 3.53 Impact Factor
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ABSTRACT: Background: Malnutrition, which is a powerful predictor of morbidity and mortality, is common in patients undergoing hemodialysis. Therefore, for a better overall outcome, adequate nutrition is very important for such patients. Objectives: The current study mainly aimed to investigate the relationship between nutritional markers, anthropometric parameters such as body mass index (BMI), and routine laboratory parameters with mortality in patients undergoing hemodialysis. Patients and Method: The demographic characteristics, mortality rate, duration of hemodialysis, serum albumin concentration, total protein, triglyceride, cholesterol, blood urea nitrogen (BUN), and creatinine of 260 patients treated from May 2001 to July 2011 were analyzed, retrospectively. The patients were followed-up regularly for one year. Lastly, the year follow-up was completed by 90 patients. Results: The results showed that statistically significant correlation between albumin serum levels (P = 0.001) and duration of hemodialysis (P = 0.001) with survival in patients undergoing hemodialysis. No statistically significant correlation was found between gender, BMI, triglyceride, cholesterol, BUN, and creatinine with survival in patients undergoing hemodialysis. Conclusions: The results of the current study suggested that low serum albumin levels and duration of hemodialysis were strong predictors of mortality and morbidity among patients undergoing hemodialysis.Shiraz E Medical Journal 05/2015; 16(2):1-5.
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ABSTRACT: Obesity is associated with chronic kidney disease progression. Whether metabolic risk factors modify this association is unclear. Here we examined associations of body mass index (BMI) and metabolic health with risk of end-stage renal disease (ESRD) in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. Among 21,840 participants eligible for analysis, 247 developed ESRD (mean follow-up of 6.3 years). Metabolic health significantly modified the association of BMI with ESRD. In models stratified by the presence or absence of the metabolic syndrome and adjusted for demographic, lifestyle, and clinical factors, higher BMI was associated with lower risk of ESRD in those without (hazard ratio per 5 kg/m(2) increase in BMI 0.70, 95% CI 0.52, 0.95) but not those with (hazard ratio, 1.06) the metabolic syndrome. In models stratified by weight and metabolic health, compared with normal weight (BMI 18.5-24.9 kg/m(2)) participants without the metabolic syndrome the overweight individuals (BMI 25-29.9) and obese individuals (BMI of 30 or more) with the metabolic syndrome had greater risk of ESRD (hazard ratios of 2.03 and 2.29, respectively), whereas obesity without the metabolic syndrome was associated with lower risk of ESRD (hazard ratio 0.47). Thus, higher BMI is associated with lower ESRD risk in those without but not those with the metabolic syndrome.Kidney International advance online publication, 17 December 2014; doi:10.1038/ki.2014.384.Kidney International 12/2014; · 8.52 Impact Factor