TY - JOUR
T1 - Influence of excess weight on mortality and hospital stay in 1346 hemodialysis patients
AU - Fleischmann, Erwin
AU - Teal, Nancy
AU - Dudley, John
AU - May, Warren
AU - Bower, John D.
AU - Salahudeen, Abdulla K.
N1 - Funding Information:
This study is made possible by a grant from the Kidney Care Inc. Foundation, Jackson, MS, USA, to Dr. Salahudeen. The authors appreciate the support of the administrative and nursing staff of the Renal Care Group, particularly Ms. Anne Bower and Ms. Paula Skeen, and the assistance of Mr. Ameen Salahudeen for data organization. Mr. Tim Bailey and Ms. Angela Parker of the Renal Care Group facilitated the computer data transfers.
PY - 1999
Y1 - 1999
N2 - Background. Body mass index (BMI) at its extremes contributes to morbidity and mortality in the general population. Its influence on morbidity and mortality in patients on hemodialysis is not clearly defined. Methods. The BMI in 1346 patients attending limited-care hemodialysis units across the state of Mississippi was determined, and its relation to one-year mortality and hospital stay was assessed using the Cox proportional hazard model. Results. Of these patients, 89% were black, and 11% were white. Thirty-eight percent of patients were overweight (BMI > 27.5), and 13% were underweight (BMI < 20). The highest (27.60 ± 0.29, mean ± SE) and the lowest (24.54 ± 0.48) BMI were noted in black females and white males, respectively. BMI, race, hematocrit (Hct), and biochemical markers of better nutrition positively influenced the survival, whereas age, serum globulin, and diabetes had a negative influence. In a Cox multivariate analysis, BMI, age, diabetes, prealbumin, and creatinine, but not race, serum albumin, Hct, or serum globulin, retained significant influence on survival. Compared with the normal weight (BMI between 20 and 27.5), the one-year survival rate was significantly higher in the overweight patients and lower in the underweight patients. With a one-unit increase in BMI over 27.5, the relative risk for dying was reduced by 30% (P < 0.04), and with a one-unit decrease in BMI below 20, the relative risk was increased by 1.6-fold (P < 0.01). Furthermore, underweight patients had significantly lower levels of biochemical markers of nutrition and higher frequency and longer duration of hospital stay. Conclusion. Adequate dialysis with special attention to proper nutrition aimed to achieve the high end of normal BMI may help to reduce the high mortality and morbidity in hemodialysis patients.
AB - Background. Body mass index (BMI) at its extremes contributes to morbidity and mortality in the general population. Its influence on morbidity and mortality in patients on hemodialysis is not clearly defined. Methods. The BMI in 1346 patients attending limited-care hemodialysis units across the state of Mississippi was determined, and its relation to one-year mortality and hospital stay was assessed using the Cox proportional hazard model. Results. Of these patients, 89% were black, and 11% were white. Thirty-eight percent of patients were overweight (BMI > 27.5), and 13% were underweight (BMI < 20). The highest (27.60 ± 0.29, mean ± SE) and the lowest (24.54 ± 0.48) BMI were noted in black females and white males, respectively. BMI, race, hematocrit (Hct), and biochemical markers of better nutrition positively influenced the survival, whereas age, serum globulin, and diabetes had a negative influence. In a Cox multivariate analysis, BMI, age, diabetes, prealbumin, and creatinine, but not race, serum albumin, Hct, or serum globulin, retained significant influence on survival. Compared with the normal weight (BMI between 20 and 27.5), the one-year survival rate was significantly higher in the overweight patients and lower in the underweight patients. With a one-unit increase in BMI over 27.5, the relative risk for dying was reduced by 30% (P < 0.04), and with a one-unit decrease in BMI below 20, the relative risk was increased by 1.6-fold (P < 0.01). Furthermore, underweight patients had significantly lower levels of biochemical markers of nutrition and higher frequency and longer duration of hospital stay. Conclusion. Adequate dialysis with special attention to proper nutrition aimed to achieve the high end of normal BMI may help to reduce the high mortality and morbidity in hemodialysis patients.
KW - African American
KW - Body mass index
KW - Dialysis
KW - Malnutrition
KW - Mortality
KW - Obesity
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U2 - 10.1046/j.1523-1755.1999.00389.x
DO - 10.1046/j.1523-1755.1999.00389.x
M3 - Article
C2 - 10201023
AN - SCOPUS:0032949230
SN - 0085-2538
VL - 55
SP - 1560
EP - 1567
JO - Kidney International
JF - Kidney International
IS - 4
ER -