Both low muscle mass and low fat are associated with higher all-cause mortality in hemodialysis patients (original) (raw)
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Journal of the American Society of Nephrology : JASN, 2015
High body mass index (BMI) is paradoxically associated with better outcome in hemodialysis (HD) patients. Persistent inflammation commonly features in clinical conditions where the obesity paradox is described. We examined the relationship between BMI and mortality in HD patients, accounting for inflammation, in a historic cohort study of 5904 incident HD patients enrolled in 2007-2009 (312 facilities; 15 European countries) with ≥3 months of follow-up. Patients were classified by presence (n=3231) or absence (n=2673) of inflammation (C-reactive protein ≥10 mg/l and/or albumin ≤35 g/l). Patients were divided into quintiles by BMI (Q1-Q5: <21.5, 21.5-24.0, >24.0-26.4, >26.4-29.8, and >29.8 kg/m(2), respectively). Noninflamed patients in BMI Q5 formed the reference group. During a median follow-up period of 36.7 months, 1929 deaths occurred (822 cardiovascular), with 655 patients censored for renal transplantation and 1183 for loss to follow-up. Greater mortality was obser...
The American journal of clinical nutrition, 2006
In maintenance hemodialysis (MHD) patients, a larger body size is associated with better survival but a worse self-reported quality of life (QoL). It is not clear whether muscle mass or body fat confers the survival advantage. We hypothesized that both a low baseline body fat percentage and a loss of fat over time were independently associated with higher mortality but with a better QoL score. In 535 adult MHD patients, body fat was measured directly with the use of near infrared interactance and QoL was measured with a Short Form 36 questionnaire. The patients were followed for < or =30 mo. Across four 12% increments of body fat at baseline, the reported QoL scores were progressively lower (P < 0.01). After a multivariate adjustment for demographics and surrogates of muscle mass and inflammation (ie, midarm muscle circumference, serum creatinine, and proinflammatory cytokines), 46 patients with body fat of <12% had a death hazard ratio (HR) 4 times that of 199 patients wit...
General Physiology and Biophysics
Muscle wasting is independent predictor of mortality in end-stage renal disease (ESRD) patients on maintenance hemodialysis (MHD). We investigated the effect of insulin resistance on lean body mass (LBM), and association between insulin resistance, chronic inflammation, and body composition in these patients. We analyzed cross-sectionally body composition, nutritional status and biochemical parameters in 35 non-diabetic ESRD patients who were on MHD. Bioelectrical impedance analysis was performed to quantify body fat, lean body mass and total body water (FAT (%), FAT (kg), LBM (%), LBM (kg) and TBW(%)). The association between LBM (kg) and gender, FAT (kg), high sensitivity C-reactive protein (hs-CRP), and homeostatic model assessment score (HOMA-IR) was recorded. Multiple linear regression analysis using LBM (kg) as dependent variable showed that FAT (kg) (beta = 0.563, p = 0.05), HOMA-IR (beta = 0.619, p = 0.03), and hs-CRP (beta = 0.488, p = 0.04) were independently associated wi...
The Association between Body Mass Index and Mortality in Incident Dialysis Patients
PloS one, 2014
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 survi...
Nutrients, 2019
The association between body fat and mortality in hemodialysis patients remains controversial. We examined the effect of percent body fat (PBF) on all-cause mortality among adequate hemodialysis patients with and without insulin resistance (IR). A prospective cohort study was conducted on 365 adequate hemodialysis patients (equilibrated Kt/V ≥ 1.2) from seven hospitals. Patients’ characteristics and clinical and biochemical parameters were assessed at baseline between September 2013 and April 2017. Patients were followed up for all-cause mortality until April 2018. The median value of homeostatic model assessment (HOMA-IR) was used to classify IR. Cox proportional hazard models were utilized to examine predictors of all-cause mortality. During 1.4 (1.0–3.2) years of follow-up, 46 patients died. In patients with IR (HOMA-IR ≥ 5.18), PBF was significantly higher in the survival group than in the death group (31.3 ± 9.0 vs. 25.4 ± 8.2, p = 0.005). After controlling for confounding factors, PBF was significantly associated with lower risk for all-cause mortality in patients with IR (hazard ratio, 0.94; 95% confidence interval, 0.89–1.00; p = 0.033). The association was not observed in patients without IR. In conclusion, percent body fat shows a protective effect on survival in hemodialysis patients with IR.
Obesity in renal failure – Health or disease?
Medical Hypotheses, 2010
The results of numerous investigations on the impact of obesity on renal insufficiency conducted in recent years introduce certain dilemmas about their mutual agreement. Some studies suggest that obesity is negatively correlated with the terminal phase of renal failure. On the other hand, other research has shown that reducing the index of body weight of patients with renal disease improves glomerular filtration. Even more confusion comes from findings indicating that metabolic syndrome in non-diabetic renal disease sufferers increases the risk of occurrence and progression of chronic renal disease. However, some research results suggest that obesity is positively correlated with survival of patients on dialysis, i.e., the higher the index of body weight the lower the mortality rate, especially with extremely obese patients. Reverse epidemiology is a term for the medical hypothesis which holds that the influence of obesity and high body weight indexes may be protective and associated with greater survival of obese patients on haemodialysis. A high serum creatinine concentration is a direct consequence of low rates of glomerular filtration and is inversely correlated with mortality rate. However, observations that high creatinine concentrations before haemodialysis treatment are a predictor of survival may be explained by the fact that they are also the direct consequence of increased muscle mass and a higher dietary protein intake. Thus, improvement of their nutritive state might delay progression and diminish the complications expected for patients suffering from kidney insufficiency. The requirements for daily protein intake by dialysis patients are not clear enough, while a hyperprotein diet may be a significant source of uraemic toxins, phosphate and H(+)-ion, which would be detrimental for their health. Some research has indicated that obesity of dialysis patients is not linked to increased risk of cardiovascular diseases in contrast to the general population. On the other hand, a low body mass index and additional parameters of malnutrition are strong independent indicators of mortality rate in dialysis patients. Although, there is a substantial amount of data that support a protective role for obesity, some authors question the existence of the obesity paradox. They do not oppose the results of that research, but suggest that obese individuals are actually protected in the short-term while later on they are liable to higher mortality risks than people of normal body weight. The role of obesity is undisputed as a significant mortality factor in the general population. Nevertheless, some well-designed studies have confirmed that obesity has a protective influence on patients treated by chronic dialysis procedures. This is not to suggest that obesity is recommended as a model for a higher survival rate in those patients, but the role of 'uraemic adipose tissue' and probable additional factors that might result in a lower mortality rate should be considered.
The American journal of clinical nutrition, 2007
Adipose tissue in overweight patients with end-stage renal disease (ESRD) is a source of proinflammatory mediators, which could contribute to protein-energy wasting (PEW), cardiovascular disease, and increased mortality. Overweight in ESRD patients, however, is reported to be associated with better survival. We investigated the associations between overweight [body mass index (BMI; in kg/m2) > 25], inflammation, PEW, and mortality in ESRD patients starting dialysis. In 328 ESRD patients (age: 53 +/- 12 y; 201 men), inflammatory biomarkers, nutritional status, and dual-energy X-ray absorptiometry data were analyzed close to the start of treatment. We compared clinical and laboratory data in patients in 3 BMI groups, with and without PEW. The prevalence of PEW was high in patients in all 3 BMI groups. PEW was associated with both high fat body mass index (FBMI) and low lean body mass index (LBMI). Both PEW and high BMI were associated with inflammation. The highest concentrations o...