Abstract
In maintenance hemodialysis (HD) patients, overweight and obesity are associated with survival advantages. Given the greater survival of maintenance HD patients who are minorities, we hypothesized that increased body mass index (BMI) is associated more strongly with lower mortality in blacks and Hispanics relative to non-Hispanic whites. Retrospective cohort study. We examined a 6-year (2001-2007) cohort of 109,605 maintenance HD patients including 39,090 blacks, 17,417 Hispanics, and 53,098 non-Hispanic white maintenance HD outpatients from DaVita dialysis clinics. Cox proportional hazards models examined the association between BMI and survival. Race and BMI. All-cause mortality. Patients had a mean age of 62 ± 15 (standard deviation) years and included 45% women and 45% patients with diabetes. Across 10 a priori-selected BMI categories (<18-≥40 kg/m(2)), higher BMI was associated with greater survival in all 3 racial/ethnic groups. However, Hispanic and black patients experienced higher survival gains compared with non-Hispanic whites across higher BMI categories. Hispanics and blacks in the ≥40-kg/m(2) category had the largest adjusted decrease in death HR with increasing BMI (0.57 [95% CI, 0.49-0.68] and 0.63 [95% CI, 0.58-0.70], respectively) compared with non-Hispanic whites in the 23- to 25-kg/m(2) group (reference category). In linear models, although the inverse BMI-mortality association was observed for all subgroups, overall black maintenance HD patients showed the largest consistent decrease in death HR with increasing BMI. Race and ethnicity categories were based on self-identified data. Whereas the survival advantage of high BMI is consistent across all racial/ethnic groups, black maintenance HD patients had the strongest and most consistent association of higher BMI with improved survival.
Highlights
In maintenance hemodialysis (HD) patients, overweight and obesity are associated with survival advantages
Whereas survival advantage of high body mass index (BMI) is consistent across all racial/ethnic groups, Black maintenance HD patients had the strongest association of high BMI with improved survival
23 million people in the U.S have chronic kidney disease (CKD) with over 400,000 having CKD stage 5 and requiring maintenance dialysis treatment to survive.[1]. According to the United States Renal Data System (USRDS), dialysis patients have an average life expectancy of 5 years, this varies by race.[2]. For example, Black and Hispanic maintenance dialysis patients have a lower mortality rate than their non-Hispanic white counterparts.[3,4,5,6] This survival advantage persists even after adjusting for such important factors as co-morbid diseases and laboratory abnormalities.[4, 7] race may confound the association between dialysis adequacy and survival.[8]. In patients with non–dialysis-dependent chronic kidney disease (CKD) racial differences are observed
Summary
We obtained, refined, and analyzed data from all individuals with chronic kidney disease (CKD) stage 5 who underwent maintenance HD treatment from July 2001 through June 2007 in one of 580 outpatient Davita Inc (prior to its acquisition of former Gambro dialysis facilities) dialysis facilities. The original 6-year (7/2001-6/2007) national database of all DaVita maintenance HD patients included 109,605 subjects (Figure S1; available as online supplementary material). The first (baseline) studied quarter for each patient was the calendar quarter in which the patient’s hemodialysis vintage was >90 days. Patients who received hemodialysis treatment in the baseline quarter and who had a BMI between 12 – 60 kg/m2 and age between 16–99 years in the baseline quarter were included in the present study
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