Mortality predictability of body size and muscle mass surrogates in asian vs white and African American hemodialysis patients

Jongha Park, Dong Chan Jin, M. Molnár, Ramanath Dukkipati, Yong Lim Kim, Jennie Jing, Nathan W. Levin, Allen R. Nissenson, Jong Soo Lee, Kamyar Kalantar-Zadeh

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Abstract

Objective: To determine whether the association of body size and muscle mass with survival among patients undergoing long-term hemodialysis (HD) is consistent across race, especially in East Asian vs white and African American patients. Patients and Methods: Using data from 20,818 patients from South Korea who underwent HD from February 1, 2001, to June 30, 2009, and 20,000 matched patients from the United States (10,000 whites and 10,000 African Americans) who underwent HD from July 1, 2001, to June 30, 2006, we compared mortality associations of baseline body mass index (BMI) and serum creatinine level as likely surrogates of obesity and muscle mass across the 3 races. Results: In Korean HD patients, higher BMI together with higher serum creatinine levels were associated with greater survival, as previously reported from US and European studies. In the matched cohort (10,000 patients from each of the 3 races), mortality risks were lower across higher BMI and serum creatinine levels, and these associations were similar in all 3 races (reference groups: patients with BMI >25.0 kg/m2 or serum creatinine >12 mg/dL in each race). White, African American, and Korean patients with BMI levels of 18.5 kg/m2 or less (underweight) had 78%, 79%, and 57%higher mortality risk, respectively, and white, African American, and Korean patients with serum creatinine levels of 6.0 mg/dL or less had 108%, 87%, and 78%higher mortality, respectively. Conclusion: This study shows that race does not modify the association of higher body size and muscle mass with greater survival in HD patients. Given the consistency of the obesity paradox, which may be related to a mitigated effect of protein-energy wasting on mortality irrespective of racial disparities, nutritional support to improve survival should be tested in HD patients of all races.

Original languageEnglish
Pages (from-to)479-486
Number of pages8
JournalMayo Clinic Proceedings
Volume88
Issue number5
DOIs
Publication statusPublished - May 2013

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Body Size
African Americans
Renal Dialysis
Muscles
Mortality
Creatinine
Body Mass Index
Serum
Survival
Obesity
Republic of Korea
Nutritional Support
Thinness

ASJC Scopus subject areas

  • Medicine(all)

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Mortality predictability of body size and muscle mass surrogates in asian vs white and African American hemodialysis patients. / Park, Jongha; Jin, Dong Chan; Molnár, M.; Dukkipati, Ramanath; Kim, Yong Lim; Jing, Jennie; Levin, Nathan W.; Nissenson, Allen R.; Lee, Jong Soo; Kalantar-Zadeh, Kamyar.

In: Mayo Clinic Proceedings, Vol. 88, No. 5, 05.2013, p. 479-486.

Research output: Contribution to journalArticle

Park, J, Jin, DC, Molnár, M, Dukkipati, R, Kim, YL, Jing, J, Levin, NW, Nissenson, AR, Lee, JS & Kalantar-Zadeh, K 2013, 'Mortality predictability of body size and muscle mass surrogates in asian vs white and African American hemodialysis patients', Mayo Clinic Proceedings, vol. 88, no. 5, pp. 479-486. https://doi.org/10.1016/j.mayocp.2013.01.025
Park, Jongha ; Jin, Dong Chan ; Molnár, M. ; Dukkipati, Ramanath ; Kim, Yong Lim ; Jing, Jennie ; Levin, Nathan W. ; Nissenson, Allen R. ; Lee, Jong Soo ; Kalantar-Zadeh, Kamyar. / Mortality predictability of body size and muscle mass surrogates in asian vs white and African American hemodialysis patients. In: Mayo Clinic Proceedings. 2013 ; Vol. 88, No. 5. pp. 479-486.
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AU - Molnár, M.

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AU - Kim, Yong Lim

AU - Jing, Jennie

AU - Levin, Nathan W.

AU - Nissenson, Allen R.

AU - Lee, Jong Soo

AU - Kalantar-Zadeh, Kamyar

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N2 - Objective: To determine whether the association of body size and muscle mass with survival among patients undergoing long-term hemodialysis (HD) is consistent across race, especially in East Asian vs white and African American patients. Patients and Methods: Using data from 20,818 patients from South Korea who underwent HD from February 1, 2001, to June 30, 2009, and 20,000 matched patients from the United States (10,000 whites and 10,000 African Americans) who underwent HD from July 1, 2001, to June 30, 2006, we compared mortality associations of baseline body mass index (BMI) and serum creatinine level as likely surrogates of obesity and muscle mass across the 3 races. Results: In Korean HD patients, higher BMI together with higher serum creatinine levels were associated with greater survival, as previously reported from US and European studies. In the matched cohort (10,000 patients from each of the 3 races), mortality risks were lower across higher BMI and serum creatinine levels, and these associations were similar in all 3 races (reference groups: patients with BMI >25.0 kg/m2 or serum creatinine >12 mg/dL in each race). White, African American, and Korean patients with BMI levels of 18.5 kg/m2 or less (underweight) had 78%, 79%, and 57%higher mortality risk, respectively, and white, African American, and Korean patients with serum creatinine levels of 6.0 mg/dL or less had 108%, 87%, and 78%higher mortality, respectively. Conclusion: This study shows that race does not modify the association of higher body size and muscle mass with greater survival in HD patients. Given the consistency of the obesity paradox, which may be related to a mitigated effect of protein-energy wasting on mortality irrespective of racial disparities, nutritional support to improve survival should be tested in HD patients of all races.

AB - Objective: To determine whether the association of body size and muscle mass with survival among patients undergoing long-term hemodialysis (HD) is consistent across race, especially in East Asian vs white and African American patients. Patients and Methods: Using data from 20,818 patients from South Korea who underwent HD from February 1, 2001, to June 30, 2009, and 20,000 matched patients from the United States (10,000 whites and 10,000 African Americans) who underwent HD from July 1, 2001, to June 30, 2006, we compared mortality associations of baseline body mass index (BMI) and serum creatinine level as likely surrogates of obesity and muscle mass across the 3 races. Results: In Korean HD patients, higher BMI together with higher serum creatinine levels were associated with greater survival, as previously reported from US and European studies. In the matched cohort (10,000 patients from each of the 3 races), mortality risks were lower across higher BMI and serum creatinine levels, and these associations were similar in all 3 races (reference groups: patients with BMI >25.0 kg/m2 or serum creatinine >12 mg/dL in each race). White, African American, and Korean patients with BMI levels of 18.5 kg/m2 or less (underweight) had 78%, 79%, and 57%higher mortality risk, respectively, and white, African American, and Korean patients with serum creatinine levels of 6.0 mg/dL or less had 108%, 87%, and 78%higher mortality, respectively. Conclusion: This study shows that race does not modify the association of higher body size and muscle mass with greater survival in HD patients. Given the consistency of the obesity paradox, which may be related to a mitigated effect of protein-energy wasting on mortality irrespective of racial disparities, nutritional support to improve survival should be tested in HD patients of all races.

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