Is there any survival advantage of obesity in Southern European haemodialysis patients?

Chazot, Charles; Gassia, J P; Benedetto, Attilio Di; Cesare, S.; Ponce, Pedro; Marcelli, Daniele

doi:10.1093/ndt/gfp168

Cited by 76 publications

(60 citation statements)

References 23 publications

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“…34,35 In contrast to trends seen in the general population, higher BMI has generally not been associated with an increase in mortality rate in patients receiving HD. [36][37][38][39][40][41] Johansen et al 40 reported that body fat and muscle mass, surrogates of body size, were both associated with improved survival in obese patients receiving HD, whereas Beddhu et al 42 showed that urinary creatinine level as a surrogate of muscle mass has a stronger association with survival than does body fat. 39,43 Only a very few studies have failed to confirm the survival advantages of obesity in patients with CKD.…”

Section: Discussionmentioning

confidence: 99%

The Obesity Paradox and Mortality Associated With Surrogates of Body Size and Muscle Mass in Patients Receiving Hemodialysis

Kalantar-Zadeh

Streja

Kövesdy

et al. 2010

Mayo Clinic Proceedings

277

235

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Objective: To determine whether dry weight gain accompanied by an increase in muscle mass is associated with a survival benefit in patients receiving maintenance hemodialysis (HD). Patients and MethOds:In a nationally representative 5-year cohort of 121,762 patients receiving HD 3 times weekly from July 1, 2001, through June 30, 2006, we examined whether body mass index (BMI) (calculated using 3-month averaged post-HD dry weight) and 3-month averaged serum creatinine levels (a likely surrogate of muscle mass) and their changes over time were predictive of mortality risk.Results: In the cohort, higher BMI (up to 45) and higher serum creatinine concentration were incrementally and independently associated with greater survival, even after extensive multivariate adjustment for available surrogates of nutritional status and inflammation. Dry weight loss or gain over time exhibited a graded association with higher rates of mortality or survival, respectively, as did changes in serum creatinine level over time. Among the 50,831 patients who survived the first 6 months and who had available data for changes in weight and creatinine level, those who lost weight but had an increased serum creatinine level had a greater survival rate than those who gained weight but had a decreased creatinine level. These associations appeared consistent across different demographic groups of patients receiving HD.cOnclusiOn: In patients receiving long-term HD, larger body size with more muscle mass appears associated with a higher survival rate. A discordant muscle gain with weight loss over time may confer more survival benefit than weight gain while losing muscle. Controlled trials of muscle-gaining interventions in patients receiving HD are warranted. Mayo Clin Proc. 2010;85(11):991-1001From the harold simmons center for chronic disease Research and epidemiology (K.K.-Z., e.s., j.j., n.n.) and division of nephrology and hypertension (K.K.-Z., j.d.K., R.M.), los angeles biomedical Research institute at harborucla Medical center, torrance, ca; ucla david Geffen school of Medicine (K.K.-Z., a.R.n., j.d.K., R.M.); department of Family health and/or epidemiology, ucla school of Public health, los angeles, ca (K.K.-Z., e.s., j.d.K.); salem veterans affairs Medical center, salem, va (c.P.K.); davita, el segundo, ca (a.R.n, M.K.); university of alberta, edmonton, alberta, canada (a.O.); and charité university school of Medicine, berlin, Germany and centre for clinical and basic Research, iRccs san Raffaele, Rome, italy (s.d.a.) the study was supported by dr Kalantar-Zadeh's research grants from the national institute of diabetes and digestive and Kidney diseases of the national institutes of health (R01 dK078106), the american heart association (0655776Y), and davita clinical Research (dcR), as well as a philanthropic grant from Mr harold simmons and an additional dcR grant for the division of nephrology & hypertension at harbor-ucla Medical center. drs nissenson and Krishnan are employees of davita. dr Kalantar-Zadeh is the medical director ...

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Section: Discussionmentioning

confidence: 99%

The Obesity Paradox and Mortality Associated With Surrogates of Body Size and Muscle Mass in Patients Receiving Hemodialysis

Kalantar-Zadeh

Streja

Kövesdy

et al. 2010

Mayo Clinic Proceedings

277

235

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“…15 Investigators increasingly reference an obesity paradox among individuals with chronic diseases, whereby obese persons have higher survival rates compared to non-obese individuals. [16][17][18][19][20][21][22][23][24] Mechanisms for this obesity paradox are not fully understood, but proposed explanations include: 1) sick individuals lose weight and become frail as a result of underlying illnesses that cause wasting; 25 2) obese, sick individuals may have greater cardiorespiratory fitness (a proxy for physical wellness) than non-obese individuals who are also sick, but more likely to be frail and unfit, 26 which is supported by a "surplus calorie theory" hypothesizing that the obese have increased calorie reserves resulting in higher serum lipid levels, less protein/muscle breakdown and less uremia; 27 3) healthy individuals without major disease or injuries experience monotonically increasing mortality risk from excess adiposity, and individuals with major diseases or injuries experience monotonically decreasing mortality risk from excess adiposity; 28,29 4) older obese individuals receive more aggressive treatment that may lead to a potentially false appearance that obesity is protective; and 5) methodological concerns related to residual confounding, survivor bias, and lead-time bias. 25,[30][31][32] Regarding diabetes, it is widely acknowledged that body weight can be influenced by disease duration and weight loss (both intentional and unintentional) following diabetes development/diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Body-Mass Index and All-Cause Mortality in US Adults With and Without Diabetes

et al. 2013

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BACKGROUND: Previous studies found normal weight compared to overweight/obese adults with type 2 diabetes had a higher mortality risk, and body-mass index (BMI)-mortality studies do not typically account for baseline diabetes status. OBJECTIVE: To determine if diabetes influences the BMI-mortality relationship. DESIGN: Using a prospective study design, we analyzed data from a nationally representative sample of US adults participating in the National Health Interview Survey from 1997 to 2002, and followed for mortality through 2006. PARTICIPANTS: Excluding those with heart disease or cancer, our final analytic sample included 74,710 (34,805 never smoker) adults. MAIN MEASURES: BMI was calculated from selfreported height and weight. Diabetes status was based on self-reported diagnosis from a health professional. We used direct age standardization to calculate allcause mortality rates and adjusted Cox models for allcause mortality hazard ratios by BMI quintile; this was done separately for adults with diabetes and without diabetes. KEY RESULTS: Among never smokers, mean age was 50.1 years and 43 % were men. Mean BMI was 27.4 kg/m 2 , 26 % were obese, and 2,035 (5 %) reported diagnosed diabetes. After 9 years, there were 4,355 deaths (754 of 4,740 with diabetes; 3,601 of 69,970 without) among 74,710 participants, and 1,238 (247 of 2,035 with diabetes; 991 of 32,770 without) among 34,805 never smokers. We observed a qualitative interaction with diabetes on the BMImortality relationship (p=0.002). Death rates were substantially higher among participants with diabetes compared to those without diabetes across all BMI quintiles. However, death rates in participants with diabetes fell with increasing BMI quintile, while rates followed a J-shaped curve among those without diabetes. In adjusted Cox models, BMI was positively associated with mortality in adults without diabetes, but inversely associated with mortality among participants with diabetes. CONCLUSIONS: Mortality increased with increasing BMI in adults without diabetes, but decreased with increasing BMI among their counterparts with diabetes. Future studies need to be better designed to answer the question of whether normal weight adults with diabetes have a higher risk of mortality, by minimizing the possibility of reverse causation. Future studies should also account for prevalent diabetes in all investigations of the BMI-mortality relationship.

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“…The paradoxical association between traditional cardiovascular risk factors and better outcomes in dialysis patients probably reflects the powerful effect-modifying impact of PEW in this population (2,3). Such is the case of the "obesity paradox," whereby a high body mass index (BMI) has been associated with longer survival in many (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) but not all (16)(17)(18)) studies of dialysis patients. Although there are various hypotheses for this paradoxical disconnect, the most likely explanation is that dialysis patients are at such high risk of PEW that excess weight provides a measure of protection (15,19).…”

Section: Introductionmentioning

confidence: 99%

Influence of Body Mass Index on the Association of Weight Changes with Mortality in Hemodialysis Patients

Cabezas-Rodríguez¹,

Carrero²,

Zoccali³

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground 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. Results Among 6296 patients with complete data, 1643 died. At study entry, 42% of patients had a normal weight (BMI, 20-25 kg/m 2 ), 11% were underweight, 31% were overweight, and 16% were obese (BMI $30 kg/m 2 ). 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.

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Is there any survival advantage of obesity in Southern European haemodialysis patients?

Cited by 76 publications

References 23 publications

The Obesity Paradox and Mortality Associated With Surrogates of Body Size and Muscle Mass in Patients Receiving Hemodialysis

The Obesity Paradox and Mortality Associated With Surrogates of Body Size and Muscle Mass in Patients Receiving Hemodialysis

Body-Mass Index and All-Cause Mortality in US Adults With and Without Diabetes

Influence of Body Mass Index on the Association of Weight Changes with Mortality in Hemodialysis Patients

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