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

Research output: Contribution to journalArticle

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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

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hemodialysis
creatinine
body mass index
Renal Dialysis
Creatinine
Hazards
Body Mass Index
Survival
gender
Risk analysis
Chemical analysis
Splines
Association reactions
Mortality
Body Composition
body composition
confidence interval
obesity
Obesity
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

Cite this

Clinical Research Center for End Stage Renal Disease (CRC for ESRD) Investigators (2018). Survival in patients on hemodialysis: Effect of gender according to body mass index and creatinine. PloS one, 13(5), [e0196550]. https://doi.org/10.1371/journal.pone.0196550
Clinical Research Center for End Stage Renal Disease (CRC for ESRD) Investigators. / Survival in patients on hemodialysis : Effect of gender according to body mass index and creatinine. In: PloS one. 2018 ; Vol. 13, No. 5.
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title = "Survival in patients on hemodialysis: Effect of gender according to body mass index and creatinine",
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.",
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Clinical Research Center for End Stage Renal Disease (CRC for ESRD) Investigators 2018, 'Survival in patients on hemodialysis: Effect of gender according to body mass index and creatinine', PloS one, vol. 13, no. 5, e0196550. https://doi.org/10.1371/journal.pone.0196550

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.

In: PloS one, Vol. 13, No. 5, e0196550, 05.2018.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Survival in patients on hemodialysis

T2 - Effect of gender according to body mass index and creatinine

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

AU - Park, Jeung Min

AU - Lee, Jong Hak

AU - Jang, Hye Min

AU - Park, Yeongwoo

AU - Kim, Yon Su

AU - Kang, Shin Wook

AU - Yang, Chul Woo

AU - Kim, Nam Ho

AU - Kwon, Eugene

AU - Kim, Hyun Ji

AU - Lee, Ji Eun

AU - Jung, Hee Yeon

AU - Choi, Ji Young

AU - Park, Sun Hee

AU - Kim, Chan Duck

AU - Cho, Jang Hee

AU - Kim, Yong Lim

PY - 2018/5

Y1 - 2018/5

N2 - 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.

AB - 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.

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Clinical Research Center for End Stage Renal Disease (CRC for ESRD) Investigators. Survival in patients on hemodialysis: Effect of gender according to body mass index and creatinine. PloS one. 2018 May;13(5). e0196550. https://doi.org/10.1371/journal.pone.0196550