Relationship Between Body Mass Index and Mortality in Adults on Maintenance Hemodialysis: A Systematic Review

Herselman, Marlien; Esau, Nazeema; Kruger, Jean-Marie; Labadarios, Demetre; Moosa, Mohammed Rafique

doi:10.1053/j.jrn.2010.03.010

Cited by 29 publications

(25 citation statements)

References 85 publications

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“…However, once ESRD is developed, obesity is paradoxically associated with greater survival [6]. This phenomenon is been described as the ‘obesity paradox', and it has been observed in certain populations such as in incident hemodialysis patients, hospitalized patients, elderly nursing home residents, and those with stroke and chronic heart failure [6,7,8,9,10,11,12,13,14]. This reversal of the obesity-mortality association has been particularly robust in hemodialysis patients [6,15,16], and it is also observed in peritoneal dialysis patients over the short term [17,18,19].…”

Section: Introductionmentioning

confidence: 99%

Association of Body Mass Index with Clinical Outcomes in Non-Dialysis-Dependent Chronic Kidney Disease: A Systematic Review and Meta-Analysis

et al. 2015

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Background: Previous studies have not shown a consistent link between body mass index (BMI) and outcomes such as mortality and kidney disease progression in non-dialysis-dependent chronic kidney disease (CKD) patients. Therefore, we aimed to complete a systematic review and meta-analysis study on this subject. Methods: We searched MEDLINE, EMBASE, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane Central Register of Controlled Trials (CENTRAL), and screened 7,123 retrieved studies for inclusion. Two investigators independently selected the studies using predefined criteria and assessed each study's quality using the Newcastle-Ottawa quality assessment scale. We meta-analyzed the results based on the BMI classification system by the WHO. Results: We included 10 studies (with a total sample size of 484,906) in the systematic review and 4 studies in the meta-analyses. The study results were generally heterogeneous. However, following reanalysis of the largest reported study and our meta-analyses, we observed that in stage 3-5 CKD, being underweight was associated with a higher risk of death while being overweight or obese class I was associated with a lower risk of death; however, obesity classes II and III were not associated with risk of death. In addition, reanalysis of the largest available study showed that a higher BMI was associated with an incrementally higher risk of kidney disease progression; however, this association was attenuated in our pooled results. For earlier stages of CKD, we could not complete meta-analyses as the studies were sparse and had heterogeneous BMI classifications and/or referent BMI groups. Conclusion: Among the group of patients with stage 3-5 CKD, we found a differential association between obesity classes I-III and mortality compared to the general population, indicating an obesity paradox in the CKD population.

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Section: Introductionmentioning

confidence: 99%

Association of Body Mass Index with Clinical Outcomes in Non-Dialysis-Dependent Chronic Kidney Disease: A Systematic Review and Meta-Analysis

et al. 2015

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“…[3] However, higher body mass index (BMI), an indicator of obesity, is paradoxically associated with survival advantage in hemodialysis patients including those waitlisted for kidney transplantation. [4-7] The association of pre -transplantation BMI (PreT-BMI) with mortality post transplant has remained uncertain in KTRs.…”

Section: Introductionmentioning

confidence: 99%

Body Mass Index and Mortality in Kidney Transplant Recipients: A Systematic Review and Meta-Analysis

et al. 2014

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Background: A higher body mass index (BMI) seems to be linked to survival advantage in maintenance hemodialysis patients. However, it is uncertain if this ‘obesity survival paradox' is also observed in kidney transplant recipients. Hence, we systematically reviewed the literature on the impact of pre-transplantation BMI on all-cause mortality in this population. Methods: We searched MEDLINE, EMBASE, Web of Science, CINAHL, and Cochrane CENTRAL for relevant studies up to July 2013. Two investigators independently selected the studies using predefined criteria, abstracted the data from the included studies, and independently assessed each study's quality using the Newcastle-Ottawa Quality Assessment Scale. In addition to the qualitative synthesis, we quantitatively pooled the results of the studies with clinical, methodological, and statistical homogeneity. Results: We screened 7,123 records, from which we included 11 studies (with a total of 305,392 participants) in this systematic review and 4 studies in the meta-analyses. In the only study that included children, obesity was linked to higher mortality in children of 6-12 years old. For adults, our meta-analyses indicated that compared to normal BMI, underweight [Hazard Ratio (HR): 1.09; 95% Confidence Interval (CI): 1.02-1.20], overweight (HR: 1.07; 95% CI: 1.04-1.12), and obese (HR: 1.20; 95% CI: 1.14-1.23) levels of BMI were associated with higher mortality. Conclusion: The presence of the obesity survival paradox is unlikely in kidney transplant recipients since both extremes of pre-transplantation BMI are linked to higher mortality in this population.

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“…BMI also provides valuable information on the global nutritional status, including both muscle mass and fat mass [17]. Several studies reported that a relationship between BMI and mortality exists in MHD patients [18]. In 40,950 dialysis patients, the Dialysis Outcomes and Practice Patterns Study reported that a lower BMI was closely associated with a higher risk of death due to cardiovascular-related causes compared with infection-related causes [19].…”

Section: Correlation Between Changes In Nutritional State and Adversementioning

confidence: 99%

“…BMI, body mass index; hCRP, high-sensitivity C-reactive protein. It is a possibility that unintentional weight loss (decrease in BMI) or decrease in serum albumin may reflect the severity of underlying disease, such as CCVD, cancer, or infections, all common causes of death [18]. However, a decrease in BMI during the MHD period might be caused by deceased protein and energy intake, nutrition losses into the dialysate, or loss of residual function.…”

Section: Correlation Between Changes In Nutritional State and Adversementioning

confidence: 99%

Effect of Progression in Malnutrition and Inflammatory Conditions on Adverse Events and Mortality in Patients on Maintenance Hemodialysis

Toyoda¹,

Kuragano

Kawada³

et al. 2019

Blood Purif

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Background/Aim: In maintenance hemodialysis (MHD), protein-energy malnutrition and chronic inflammation can be critical and are two of the main causes of mortality. Method: We compared the change in nutrition and inflammatory conditions between younger and older MHD patients during a 2-year period. Furthermore, using Kaplan-Meier analysis, we evaluated the correlations between changes in each parameter and any adverse events. Result: During the observational period, body mass index (BMI) and serum albumin levels decreased significantly in older patients. In Kaplan-Meier analysis, patients who showed a decline in BMI had an associated elevated risk for cerebro-cardiovascular disease and hospitalization. Moreover, patients who showed a decline in albumin also had an associated higher risk for infectious disease and hospitalization. Conclusion: This study revealed that the downward trend in nutritional status was prominent in elderly patients. Furthermore, changes in nutritional and inflammatory conditions during MHD were associated with adverse events in MHD patients.

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Relationship Between Body Mass Index and Mortality in Adults on Maintenance Hemodialysis: A Systematic Review

Cited by 29 publications

References 85 publications

Association of Body Mass Index with Clinical Outcomes in Non-Dialysis-Dependent Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Association of Body Mass Index with Clinical Outcomes in Non-Dialysis-Dependent Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Body Mass Index and Mortality in Kidney Transplant Recipients: A Systematic Review and Meta-Analysis

Effect of Progression in Malnutrition and Inflammatory Conditions on Adverse Events and Mortality in Patients on Maintenance Hemodialysis

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