Survival in patients on hemodialysis: Effect of gender according to body mass index and creatinine

Clinical Research Center for End Stage Renal Disease (CRC for ESRD) Investigators

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6 Citations (Scopus)

Abstract

Background The association of a higher body mass index (BMI) with better survival is a well-known “obesity paradox” in patients on hemodialysis (HD). However, men and women have different body compositions, which could impact the effect of BMI on mortality. We investigated the effect of gender on the obesity-mortality relationship in Korean patients on HD. Methods This study included 2,833 maintenance patients on HD from a multicenter prospective cohort study in Korea (NCT00931970). The relationship between categorized BMI and gender-specific mortality was evaluated by an adjusted Cox proportional hazard model with restricted cubic spline analyses and the Competing risk analysis. We also investigated the effect of changes in BMI over 12 months and serum creatinine level on survival in male and female patients on HD. Results The mean BMI was 22.6 ± 3.3 kg/m2 and the mean follow up duration was 24.2 ± 3.4 months. The patients with the highest quintile of BMI (25.1 kg/m2) showed lower mortality (subdistributional hazard ratio [SHR] = 0.63, 95% confidence interval [CI] = 0.43–0.93, P = 0.019) compared with those with the reference BMI quintile. When analyzed by gender, male patients with a BMI over 25.1 kg/m2 had lower mortality risk (HR = 0.43, 95% CI = 0.25–0.75, P = 0.003); however, no significant difference was found in female patients. Increased BMI after 12 months and high serum creatinine were associated with better survival only in male patients on HD. Conclusions BMI could be used as a risk factor for mortality in male patients on HD. However, the mortality of female patients on HD was not related with baseline and follow-up BMI. This suggests that BMI is a good surrogate marker of lean body composition, especially in male patients on HD.

Original languageEnglish
Article numbere0196550
JournalPloS one
Volume13
Issue number5
DOIs
Publication statusPublished - 2018 May

Bibliographical note

Funding Information:
This research was supported by a grant of the Korean Healthcare Technology R&D Project through the Korea Health Industry Development Institute (KHIDI, URL: http://www.khidi.or.kr/kps, recipient: YLK), funded by the Ministry of Health and Welfare, Republic of Korea (URL: http://www. mohw.go.kr, recipient: YLK) (HI15C0001 and HC15C1129). We thank the investigators of CRC for ESRD in Korea. The members of the Clinical Research Center for End Stage Renal Disease (CRC for ESRD) are: Do J.Y. at Yeungnam University Medical Center; Song S.H. at Pusan National University Hospital; Kim S.E. at Dong-a University Medical Center; Kim S.H. at Daegu Fatima Hospital; Kim Y.H. at Inje University Paik Hospital; Lee J.S. at Ulsan University Hospital; Jin H.J. at Seoul National University Bundang Hospital; Lim C.S. and Lee J.P. at Seoul National University Boramae Medical Center; Chang J.H. at Gachon University Gil Medical Center; Yoo T.H., Park J.T. and Oh H.J. at Yonsei University Severance Hospital; Park H.C. at Yonsei University Gangnam Severance Hospital; Chang T.I. at National Health Insurance Corporation Ilsan Hospital; Ryu D.R. at Ehwa Womens University Mokdong Hospital; Oh D.J. at Kwandong University Myongji Hospital; Chang Y.S. at The Catholic University of Korea St. Mary’s Hospital; Kim Y.O. at The Catholic University of Korea Uijeongbu St. Mary’s Hospital; Kim S.H. at Chung-Ang University Medical Center; Jin D.C. at The Catholic University of Korea St. Vincent’s Hospital; Kim Y.K. at The Catholic University of Korea, Bucheon St. Mary’s Hospital; Kim H. Y. at Chungbuk National University Hospital; Kim W. at Chonbuk National University Hospital; Lee K.W. at Chungnam National University Hospital; and Lee C.S. at Cheju Halla General Hospital.

Funding Information:
This research was supported by a grant of the Korean Healthcare Technology R&D Project through the Korea Health Industry Development Institute (KHIDI, URL: http://www.khidi.or.kr/kps, recipient: YLK), funded by the Ministry of Health and Welfare, Republic of Korea (URL: http://www. mohw.go.kr, recipient: YLK) (HI15C0001 and HC15C1129). We thank the investigators of CRC for ESRD in Korea. The members of the Clinical Research Center for End Stage Renal Disease (CRC for ESRD) are: Do J.Y. at Yeungnam University Medical Center; Song S.H. at Pusan National University Hospital; Kim S.E. at Dong-a University Medical Center; Kim S.H. at Daegu Fatima Hospital; Kim Y.H. at Inje University Paik Hospital; Lee J.S. at Ulsan University Hospital; Jin H.J. at Seoul National University Bundang Hospital; Lim C.S. and Lee J.P. at Seoul National University Boramae Medical Center; Chang J.H. at Gachon University Gil Medical Center; Yoo T.H., Park J.T. and Oh H.J. at Yonsei University Severance Hospital; Park H.C. at Yonsei University Gangnam Severance Hospital; Chang T.I. at National Health Insurance Corporation Ilsan Hospital; Ryu D.R. at Ehwa Womens University Mokdong Hospital; Oh D.J. at Kwandong University Myongji Hospital; Chang Y.S. at The Catholic University of Korea St. Mary?s Hospital; Kim Y.O. at The Catholic University of Korea Uijeongbu St. Mary?s Hospital; Kim S.H. at Chung-Ang University Medical Center; Jin D.C. at The Catholic University of Korea St. Vincent?s Hospital; Kim Y.K. at The Catholic University of Korea, Bucheon St. Mary?s Hospital; Kim H. Y. at Chungbuk National University Hospital; Kim W. at Chonbuk National University Hospital; Lee K.W. at Chungnam National University Hospital; and Lee C.S. at Cheju Halla General Hospital.

Publisher Copyright:
© 2018 Park et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

All Science Journal Classification (ASJC) codes

  • General

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