Influence of body mass index on the association of weight changes with mortality in hemodialysis patients

Iván Cabezas-Rodriguez, Juan Jesús Carrero, Carmine Zoccali, Abdul Rashid Qureshi, Markus Ketteler, Jürgen Floege, Ǵrard London, Francesco Locatelli, José Luis Gorriz, Boleslaw Rutkowski, Dimitrios Memmos, Anibal Ferreira, Adrian Covic, Vladimir Teplan, Willem Jan Bos, Reinhard Kramar, Drasko Pavlovic, David Goldsmith, J. Nagy, Miha BenedikDierik Verbeelen, Christian Tielemans, Rudolf P. Wüthrich, Pierre Yves Martin, Carlos Martínez-Salgado, José Luis Fernández-Martín, Jorge B. Cannata-Andia

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Background 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. Design, Setting, Participants, & Measurements The Current Management of Secondary Hyperparathyroidism: A Multicenter Observational Study (COSMOS) is an observational study including 6797 European hemodialysis patients recruited between February 2005 and July 2007, with prospective data collection every 6 months for 3 years. Time-dependent Cox proportional hazard regressions assessed the effect of BMI and weight changes on mortality. Analyses were performed after patient stratification according to their starting BMI.Results Among 6296 patients with complete data, 1643 died. At study entry, 42% of patients had a normal weight (BMI, 20-25 kg/m2), 11% were underweight, 31% were overweight, and 16% were obese (BMI ≥30 kg/m2). Weight loss or gain (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.

Original languageEnglish
Pages (from-to)1725-1733
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Volume8
Issue number10
DOIs
Publication statusPublished - Oct 7 2013

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Renal Dialysis
Body Mass Index
Weights and Measures
Mortality
Weight Loss
Weight Gain
Thinness
Observational Studies
Confidence Intervals
Secondary Hyperparathyroidism
Multicenter Studies
Survival Rate
Body Weight
Survival
Health

ASJC Scopus subject areas

  • Nephrology
  • Transplantation
  • Epidemiology
  • Critical Care and Intensive Care Medicine

Cite this

Cabezas-Rodriguez, I., Carrero, J. J., Zoccali, C., Qureshi, A. R., Ketteler, M., Floege, J., ... Cannata-Andia, J. B. (2013). Influence of body mass index on the association of weight changes with mortality in hemodialysis patients. Clinical Journal of the American Society of Nephrology, 8(10), 1725-1733. https://doi.org/10.2215/CJN.10951012

Influence of body mass index on the association of weight changes with mortality in hemodialysis patients. / Cabezas-Rodriguez, Iván; Carrero, Juan Jesús; Zoccali, Carmine; Qureshi, Abdul Rashid; Ketteler, Markus; Floege, Jürgen; London, Ǵrard; Locatelli, Francesco; Gorriz, José Luis; Rutkowski, Boleslaw; Memmos, Dimitrios; Ferreira, Anibal; Covic, Adrian; Teplan, Vladimir; Bos, Willem Jan; Kramar, Reinhard; Pavlovic, Drasko; Goldsmith, David; Nagy, J.; Benedik, Miha; Verbeelen, Dierik; Tielemans, Christian; Wüthrich, Rudolf P.; Martin, Pierre Yves; Martínez-Salgado, Carlos; Fernández-Martín, José Luis; Cannata-Andia, Jorge B.

In: Clinical Journal of the American Society of Nephrology, Vol. 8, No. 10, 07.10.2013, p. 1725-1733.

Research output: Contribution to journalArticle

Cabezas-Rodriguez, I, Carrero, JJ, Zoccali, C, Qureshi, AR, Ketteler, M, Floege, J, London, Ǵ, Locatelli, F, Gorriz, JL, Rutkowski, B, Memmos, D, Ferreira, A, Covic, A, Teplan, V, Bos, WJ, Kramar, R, Pavlovic, D, Goldsmith, D, Nagy, J, Benedik, M, Verbeelen, D, Tielemans, C, Wüthrich, RP, Martin, PY, Martínez-Salgado, C, Fernández-Martín, JL & Cannata-Andia, JB 2013, 'Influence of body mass index on the association of weight changes with mortality in hemodialysis patients', Clinical Journal of the American Society of Nephrology, vol. 8, no. 10, pp. 1725-1733. https://doi.org/10.2215/CJN.10951012
Cabezas-Rodriguez, Iván ; Carrero, Juan Jesús ; Zoccali, Carmine ; Qureshi, Abdul Rashid ; Ketteler, Markus ; Floege, Jürgen ; London, Ǵrard ; Locatelli, Francesco ; Gorriz, José Luis ; Rutkowski, Boleslaw ; Memmos, Dimitrios ; Ferreira, Anibal ; Covic, Adrian ; Teplan, Vladimir ; Bos, Willem Jan ; Kramar, Reinhard ; Pavlovic, Drasko ; Goldsmith, David ; Nagy, J. ; Benedik, Miha ; Verbeelen, Dierik ; Tielemans, Christian ; Wüthrich, Rudolf P. ; Martin, Pierre Yves ; Martínez-Salgado, Carlos ; Fernández-Martín, José Luis ; Cannata-Andia, Jorge B. / Influence of body mass index on the association of weight changes with mortality in hemodialysis patients. In: Clinical Journal of the American Society of Nephrology. 2013 ; Vol. 8, No. 10. pp. 1725-1733.
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AU - Cabezas-Rodriguez, Iván

AU - Carrero, Juan Jesús

AU - Zoccali, Carmine

AU - Qureshi, Abdul Rashid

AU - Ketteler, Markus

AU - Floege, Jürgen

AU - London, Ǵrard

AU - Locatelli, Francesco

AU - Gorriz, José Luis

AU - Rutkowski, Boleslaw

AU - Memmos, Dimitrios

AU - Ferreira, Anibal

AU - Covic, Adrian

AU - Teplan, Vladimir

AU - Bos, Willem Jan

AU - Kramar, Reinhard

AU - Pavlovic, Drasko

AU - Goldsmith, David

AU - Nagy, J.

AU - Benedik, Miha

AU - Verbeelen, Dierik

AU - Tielemans, Christian

AU - Wüthrich, Rudolf P.

AU - Martin, Pierre Yves

AU - Martínez-Salgado, Carlos

AU - Fernández-Martín, José Luis

AU - Cannata-Andia, Jorge B.

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N2 - Background 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. Design, Setting, Participants, & Measurements The Current Management of Secondary Hyperparathyroidism: A Multicenter Observational Study (COSMOS) is an observational study including 6797 European hemodialysis patients recruited between February 2005 and July 2007, with prospective data collection every 6 months for 3 years. Time-dependent Cox proportional hazard regressions assessed the effect of BMI and weight changes on mortality. Analyses were performed after patient stratification according to their starting BMI.Results Among 6296 patients with complete data, 1643 died. At study entry, 42% of patients had a normal weight (BMI, 20-25 kg/m2), 11% were underweight, 31% were overweight, and 16% were obese (BMI ≥30 kg/m2). Weight loss or gain (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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