Survival advantage in Asian American end-stage renal disease patients

Wong, Janus Siu Him; Port, Friedrich K.; Hulbert-Shearon, Tempie E.; Carroll, Caitlin; Wolfe, Robert A.; Agodoa, Lawrence Y.; Daugirdas, John T.

doi:10.1046/j.1523-1755.1999.00464.x

Cited by 201 publications

(143 citation statements)

References 11 publications

(2 reference statements)

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“…In contrast to our study, these disparate previous studies of HD recipients in the United States or Canada reported that adjustment for case-mix and laboratory variables yielded persistent survival advantages for racial/ethnic minority groups (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). The overall adjusted point estimates for survival relative to white or non-Hispanic white patients were 0.78 (9) Using more comprehensive covariate adjustment, our results (Table 3) .…”

Section: Discussioncontrasting

confidence: 99%

“…The validity of our findings is supported by the significance of the adjusted associations with mortality for numerous patient characteristics other than race/ethnicity that are commonly linked to higher mortality ( Table 3). The findings generalize to the maintenance HD population in the United States because the American arm of DOPPS I is a nationally representative sample (38) and because of the similarity between the unadjusted survival advantages for racial/ethnic minorities that we report and those in previous studies (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16).…”

Section: Discussionsupporting

confidence: 69%

“…Adjusted mortality rates among Hispanic patients on dialysis were 23% lower than for non-Hispanic patients. Adjusted analyses of other large dialysis databases in the past two decades have demonstrated survival advantages of similar or greater magnitude compared with white or non-Hispanic white patients for patients of disparate racial or ethnic minority categories (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16).…”

Section: H Emodialysis (Hd) Patients Who Are Hispanic or Members Of Rmentioning

confidence: 99%

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Revisiting Survival Differences by Race and Ethnicity among Hemodialysis Patients

Robinson¹,

Joffe²,

Pisoni³

et al. 2006

Journal of the American Society of Nephrology

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 69%

Section: H Emodialysis (Hd) Patients Who Are Hispanic or Members Of Rmentioning

confidence: 99%

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Revisiting Survival Differences by Race and Ethnicity among Hemodialysis Patients

Robinson¹,

Joffe²,

Pisoni³

et al. 2006

Journal of the American Society of Nephrology

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“…Finally, although we found an increased mortality risk in obese PD patients, we have no data for a comparison of the impact of obesity on mortality between PD and HD patients. Given that an increased mortality risk with obesity has also been reported in Asian American and Japanese HD patients (9,27), our findings cannot be used to judge whether obese patients should be dialyzed with HD or PD.…”

Section: Discussionmentioning

confidence: 88%

Body Mass Index and Mortality Risk in Asian Peritoneal Dialysis Patients in Hong Kong—Impact of Diabetes and Cardiovascular Disease Status

et al. 2014

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♦ Background: Obesity increases mortality in the general population, but improves survival in hemodialysis patients. In peritoneal dialysis (PD) patients, the reported effect is controversial. We investigated the effect of body mass index (BMI) on patient survival in Asian PD patients. KEY WORDS: Body mass index; cardiovascular disease; diabetes; mortality.In the general population, body mass index (BMI) has an influence on health risk and survival. Increased risks for cardiovascular disease (CVD), diabetes mellitus (DM), and mortality are found in patients with overweight and obesity. A J-or V-shaped relationship between BMI and mortality risk is well documented in the general population, meaning that, although mortality increases with BMI, individuals with low a BMI also experience increased mortality, although not as high as that in obese individuals (1-5). However, in hemodialysis (HD) patients, higher BMI carries a protective effect with respect to patient survival (6-10)-a finding described as a "reverse epidemiology" phenomenon (11). In contrast, the impact of BMI on survival in peritoneal dialysis (PD) patients is inconsistent. Some studies have suggested a similar protective effect of BMI (12-15), some have suggested a neutral effect (11,16), and some have indicated that survival is worse in obese patients (17,18).The relationship between BMI and mortality might be different in dialysis patients of different ethnicities. Wong et al. (9) were the first to report a difference in the impact of BMI on survival in white and Asian HD patients within the United States. In contrast to the typical reverse epidemiology pattern found in white HD patients, Asian HD patients in the United States demonstrated a V-shaped mortality risk relationship, with the lowest risk found in the middle-quintile BMI group, corresponding to a BMI of approximately 23 kg/ m 2 . (The middle-quintile BMI for Caucasians is approximately 25 kg/m 2 .) This V-shaped relationship somewhat simulates the relationship in the general population (5). McDonald et al. (17) also found that the relationship was different in white and Pacific Islander PD patients in Australia and New Zealand. However, there is a paucity of such information for Asian PD populations living in Asia. It is also plausible that the relationship between mortality risk and BMI differs not only

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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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Survival advantage in Asian American end-stage renal disease patients

Cited by 201 publications

References 11 publications

Revisiting Survival Differences by Race and Ethnicity among Hemodialysis Patients

Revisiting Survival Differences by Race and Ethnicity among Hemodialysis Patients

Body Mass Index and Mortality Risk in Asian Peritoneal Dialysis Patients in Hong Kong—Impact of Diabetes and Cardiovascular Disease Status

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

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