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Association Between Body Mass and Mortality in Maintenance Hemodialysis Patients
Author(s) -
Yen TzungHai,
Lin JaLiang,
LinTan DanTzu,
Hsu ChingWei
Publication year - 2010
Publication title -
therapeutic apheresis and dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.415
H-Index - 53
eISSN - 1744-9987
pISSN - 1744-9979
DOI - 10.1111/j.1744-9987.2010.00818.x
Subject(s) - medicine , underweight , hemodialysis , overweight , creatinine , diabetes mellitus , body mass index , gastroenterology , endocrinology
A total of 959 Taiwanese patients undergoing maintenance hemodialysis—102 underweight (BMI < 18.5 kg/m 2 ), 492 normal weight (BMI 18.5–22.9 kg/m 2 ), 187 overweight (BMI 23.0–24.9 kg/m 2 ), and 178 obese (BMI ≥ 25 kg/m 2 ) were recruited into this three‐year, multicenter longitudinal study. It was found initially that the underweight group had more females, longer hemodialysis durations, less use of a biocompatible membrane (BCM) dialyzer, higher erythropoietin doses and Kt/V urea , and lower white blood cell counts, hemoglobin, serum creatinine and phosphate, and high sensitivity C‐reactive protein (hsCRP) than other groups ( P < 0.001). Furthermore, a χ 2 ‐test demonstrated that underweight patients had poorer nutrition ( P = 0.023), but less systemic inflammation ( P < 0.001) than other groups. A stepwise multiple linear regression analysis established that age, sex, diabetes mellitus, hemodialysis duration, use of BCM dialyzer, Kt/V urea , creatinine, high‐density lipoprotein cholesterol, and hsCRP were significant risk factors associated with BMI ( P < 0.001–0.002). After three years, 149 (15.5%) patients had died, including 22 of 102 (21.6%) underweight patients, 64 of 492 (13.0%) normal weight patients, 38 of 187 (20.3%) overweight patients, and 25 of 178 (15.5%) obese patients. The primary causes of mortality were cardiovascular (52.3%) and infection (39.6%). A multivariate Cox regression analysis revealed that age, diabetes mellitus, BMI, albumin, hsCRP, and cardiothoracic ratio were significant risk factors associated with all‐cause mortality over three years ( P < 0.001–0.022). Finally, Kaplan–Meier analysis confirmed that underweight patients suffer higher mortality than other groups (Log rank, P = 0.0392); therefore, the data have demonstrated a survival disadvantage of low BMI in Taiwanese patients undergoing maintenance hemodialysis.