Influence of body mass index on the association of weight changes with mortality in hemodialysis patients

Iván Cabezas-Rodriguez, Juan Jesús Carrero, Carmine Zoccali, Abdul Rashid Qureshi, Markus Ketteler, Jürgen Floege, Ǵrard London, Francesco Locatelli, José Luis Gorriz, Boleslaw Rutkowski, Dimitrios Memmos, Anibal Ferreira, Adrian Covic, Vladimir Teplan, Willem Jan Bos, Reinhard Kramar, Drasko Pavlovic, David Goldsmith, Judit Nagy, Miha BenedikDierik Verbeelen, Christian Tielemans, Rudolf P. Wüthrich, Pierre Yves Martin, Carlos Martínez-Salgado, José Luis Fernández-Martín, Jorge B. Cannata-Andia

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Background and Objectives A high body mass index (BMI) is associated with lower mortality in patients undergoing hemodialysis. Short-term weight gains and losses are also related to lower and higher mortality risk, respectively. The implications of weight gain or loss may, however, differ between obese individuals and their nonobese counterparts. Design, Setting, Participants, & Measurements The Current Management of Secondary Hyperparathyroidism: A Multicenter Observational Study (COSMOS) is an observational study including 6797 European hemodialysis patients recruited between February 2005 and July 2007, with prospective data collection every 6 months for 3 years. Time-dependent Cox proportional hazard regressions assessed the effect of BMI and weight changes on mortality. Analyses were performed after patient stratification according to their starting BMI.Results Among 6296 patients with complete data, 1643 died. At study entry, 42% of patients had a normal weight (BMI, 20-25 kg/m2), 11% were underweight, 31% were overweight, and 16% were obese (BMI ≥30 kg/m2). Weight loss or gain (<1% or >1% of body weight) was strongly associated with higher rates of mortality or survival, respectively. After stratification by BMI categories, this was true in nonobese categories and especially in underweight patients. In obese patients, however, the association between weight loss and mortality was attenuated (hazard ratio, 1.28 [95% confidence interval (CI), 0.74 to 2.14]), and no survival benefit of gaining weight was seen (hazard ratio, 0.98 [95% CI, 0.59 to 1.62]). Conclusions Assuming that these weight changes were unintentional, our study brings attention to rapid weight variations as a clinical sign of health monitoring in hemodialysis patients. In addition, a patient's BMI modifies the strength of the association between weight changes with mortality.

Original languageEnglish
Pages (from-to)1725-1733
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Volume8
Issue number10
DOIs
Publication statusPublished - 7 Oct 2013

Keywords

  • CHRONIC KIDNEY-DISEASE
  • STAGE RENAL-DISEASE
  • OBESITY PARADOX
  • MAINTENANCE HEMODIALYSIS
  • SURVIVAL ADVANTAGE
  • DIALYSIS PATIENTS
  • TERM SURVIVAL
  • ALL-CAUSE
  • POPULATION
  • OUTCOMES

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