Influence of excess weight on mortality and hospital stay in 1346 hemodialysis patients

Fleischmann, Erwin H.; Teal, Nancy; Dudley, J. M.; May, Warren; Bower, John D.; Salahudeen, Abdulla K.

doi:10.1046/j.1523-1755.1999.00389.x

Cited by 420 publications

(277 citation statements)

References 8 publications

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“…34,35 In contrast to trends seen in the general population, higher BMI has generally not been associated with an increase in mortality rate in patients receiving HD. [36][37][38][39][40][41] Johansen et al 40 reported that body fat and muscle mass, surrogates of body size, were both associated with improved survival in obese patients receiving HD, whereas Beddhu et al 42 showed that urinary creatinine level as a surrogate of muscle mass has a stronger association with survival than does body fat. 39,43 Only a very few studies have failed to confirm the survival advantages of obesity in patients with CKD.…”

Section: Discussionmentioning

confidence: 99%

The Obesity Paradox and Mortality Associated With Surrogates of Body Size and Muscle Mass in Patients Receiving Hemodialysis

Kalantar-Zadeh

Streja

Kövesdy

et al. 2010

Mayo Clinic Proceedings

288

235

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Objective: To determine whether dry weight gain accompanied by an increase in muscle mass is associated with a survival benefit in patients receiving maintenance hemodialysis (HD). Patients and MethOds:In a nationally representative 5-year cohort of 121,762 patients receiving HD 3 times weekly from July 1, 2001, through June 30, 2006, we examined whether body mass index (BMI) (calculated using 3-month averaged post-HD dry weight) and 3-month averaged serum creatinine levels (a likely surrogate of muscle mass) and their changes over time were predictive of mortality risk.Results: In the cohort, higher BMI (up to 45) and higher serum creatinine concentration were incrementally and independently associated with greater survival, even after extensive multivariate adjustment for available surrogates of nutritional status and inflammation. Dry weight loss or gain over time exhibited a graded association with higher rates of mortality or survival, respectively, as did changes in serum creatinine level over time. Among the 50,831 patients who survived the first 6 months and who had available data for changes in weight and creatinine level, those who lost weight but had an increased serum creatinine level had a greater survival rate than those who gained weight but had a decreased creatinine level. These associations appeared consistent across different demographic groups of patients receiving HD.cOnclusiOn: In patients receiving long-term HD, larger body size with more muscle mass appears associated with a higher survival rate. A discordant muscle gain with weight loss over time may confer more survival benefit than weight gain while losing muscle. Controlled trials of muscle-gaining interventions in patients receiving HD are warranted. Mayo Clin Proc. 2010;85(11):991-1001From the harold simmons center for chronic disease Research and epidemiology (K.K.-Z., e.s., j.j., n.n.) and division of nephrology and hypertension (K.K.-Z., j.d.K., R.M.), los angeles biomedical Research institute at harborucla Medical center, torrance, ca; ucla david Geffen school of Medicine (K.K.-Z., a.R.n., j.d.K., R.M.); department of Family health and/or epidemiology, ucla school of Public health, los angeles, ca (K.K.-Z., e.s., j.d.K.); salem veterans affairs Medical center, salem, va (c.P.K.); davita, el segundo, ca (a.R.n, M.K.); university of alberta, edmonton, alberta, canada (a.O.); and charité university school of Medicine, berlin, Germany and centre for clinical and basic Research, iRccs san Raffaele, Rome, italy (s.d.a.) the study was supported by dr Kalantar-Zadeh's research grants from the national institute of diabetes and digestive and Kidney diseases of the national institutes of health (R01 dK078106), the american heart association (0655776Y), and davita clinical Research (dcR), as well as a philanthropic grant from Mr harold simmons and an additional dcR grant for the division of nephrology & hypertension at harbor-ucla Medical center. drs nissenson and Krishnan are employees of davita. dr Kalantar-Zadeh is the medical director ...

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Section: Discussionmentioning

confidence: 99%

The Obesity Paradox and Mortality Associated With Surrogates of Body Size and Muscle Mass in Patients Receiving Hemodialysis

Kalantar-Zadeh

Streja

Kövesdy

et al. 2010

Mayo Clinic Proceedings

288

235

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“…The increasing BMI among patients who initiate dialysis certainly will influence the total number of patients who receive dialysis in the next decade. In contrast to the general population (13), obesity is associated with improved survival (10,14,15) and decreased hospitalization rates (10) among patients with ESRD. Using data on Ͼ400,000 incident dialysis patients during the period 1995 to 2000, Johansen et al (10) noted an approximately 20% lower mortality risk among those with a BMI Ͼ37 kg/m 2 at dialysis initiation compared with patients with a BMI between 22 and Ͻ24.9 kg/m 2 at dialysis initiation.…”

Section: Discussionmentioning

confidence: 99%

Increasing Body Mass Index and Obesity in the Incident ESRD Population

Kramer

Saranathan²,

Luke³

et al. 2006

Journal of the American Society of Nephrology

304

188

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An increase in obesity prevalence among patients who initiate dialysis may influence the growth of the total ESRD population as a result of improved survival and decreased likelihood for transplantation. Temporal trends in mean body mass index (BMI) and obesity prevalence were examined among incident patients with ESRD by year of dialysis initiation between 1995 and 2002, and these trends were compared with those in the US population during this same period. Among incident dialysis patients, BMI was calculated with the height and estimated dry weight collected from the Centers for Medicare and Medicaid Services End-Stage Renal Disease Medical Evidence Form. In the US population, self-reported height and weight were used. Prevalence of total obesity and obesity stage >2 were defined as a BMI >30 and >35 kg/m 2 , respectively. Among incident patients with ESRD, mean BMI increased from 25.7 to 27.5 kg/m 2 , and total obesity and obesity stage >2 increased by 33 and 63%, respectively, among incident patients with ESRD (P < 0.0001 for obesity trends). BMI slope was approximately two-fold higher in the incident ESRD population compared with the US population for all age groups. However, temporal increases in obesity prevalence were similar between the two populations. As a result of the survival advantage associated with obesity and decreased likelihood for transplantation, these trends most likely will influence the total number of patients who receive dialysis in the next decade. O besity has reached epidemic proportions in the United States and continues to be a growing problem worldwide. In the past 20 yr, the prevalence of obesity among adults aged 20 to 74 yr has doubled from 15 to 30% (1), whereas the number of morbidly obese adults in the United States has quadrupled from 1 in 200 adults to in 1 in 50 (2). Congruent with the obesity epidemic is a growing number of adults with end-stage renal disease ESRD, a population that is expected to double in number during the next decade (3). Obesity increases the risk for diabetes and hypertension, the two primary causes of ESRD in the United States (4), and may itself be an independent risk factor for kidney disease as a result of glomerular hyperfiltration and activation of the renin-angiotensin system (5-7). In addition, obesity is associated with improved survival in patients with ESRD (8 -10) and decreased likelihood for kidney transplantation; therefore, an increase in obesity prevalence among incident dialysis patients most likely will influence the growth of the total ESRD population. J Am Soc NephrolWe examined mean body mass index (BMI) and obesity prevalence among incident patients with ESRD by year of dialysis initiation to test the hypothesis that BMI and obesity prevalence is increasing in this population. We examined both total obesity (BMI Ն 30 kg/m 2 ) and obesity stage Ն2 (BMI Ն 35 kg/m 2 ) because many medical centers preclude kidney transplantation in adults with this stage of obesity (11). Temporal trends in obesity prevalence in the ESRD population...

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“…[3,4] Similarly, extremes of underweight have recently been described as a risk factor for surgery. [5][6][7] Several recent studies of critically and chronically ill patients, [8][9][10][11] and of patients undergoing certain procedures [12][13][14][15] suggest that overweight and obese patients may paradoxically have better outcomes than underweight patients, given an increased risk for death and catastrophic complications in the latter patients.…”

Section: Introductionmentioning

confidence: 99%

An analysis of underweight status on 30-day outcomes after breast reconstruction

Eid¹,

Halen²

2015

Plast Aesthet Res

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Aim:To examine the impact of underweight body mass index (BMI) values on breast reconstruction outcomes. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was retrospectively reviewed for all patients who underwent breast reconstruction between 2006 and 2011. Patients were first stratified by breast reconstruction modality into prosthetic or autologous cohorts, and second by BMI values into underweight (BMI < 18.5), normal to overweight (reference, BMI 18.5-29.99), moderate obesity (BMI 30-34.99), severe obesity (BMI 35-39.99), and morbid obesity cohorts. Multivariate logistic regression models were used to determine independent predictors of complications. Results: With regard to prosthetic breast reconstruction patients, obese patients demonstrated increased rates of surgical complications, while underweight patients did not have any differences on multivariable analysis. With respect to autologous reconstruction, risk-adjusted multivariate regression models showed a dose dependent response between obesity and risk for surgical complications and reoperation, but not for underweight patients. Conclusion: On multivariable analysis of over 4,600 patients, there were no significant differences in the rates of adverse events between underweight patients (BMI < 18.5) and their reference-weight counterparts, in spite of a significant increase in surgical and medical complication rates in underweight patients on univariate analysis.

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Influence of excess weight on mortality and hospital stay in 1346 hemodialysis patients

Abstract: Adequate dialysis with special attention to proper nutrition aimed to achieve the high end of normal BMI may help to reduce the high mortality and morbidity in hemodialysis patients.

Cited by 420 publications

References 8 publications

The Obesity Paradox and Mortality Associated With Surrogates of Body Size and Muscle Mass in Patients Receiving Hemodialysis

The Obesity Paradox and Mortality Associated With Surrogates of Body Size and Muscle Mass in Patients Receiving Hemodialysis

Increasing Body Mass Index and Obesity in the Incident ESRD Population

An analysis of underweight status on 30-day outcomes after breast reconstruction

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