Abstract
In patients with chronic kidney disease (CKD), low body mass index (BMI) is associated with high mortality. This relationship in emergently hospitalized CKD patients is unknown. We investigated the association between obesity and short-term mortality in emergently admitted patients with dialysis-independent CKD (DI-CKD) with and without infection. This retrospective cohort study examined Diagnosis Procedure Combination data of 26103 emergently hospitalized DI-CKD patients. Patients were divided into 8 groups according to their BMI and the presence of infectious diseases. The primary outcome was in-hospital death within 100 days. Cox proportional hazards models adjusted for baseline characteristics showed that low BMI was associated with the outcome both in infected and in non-infected patients (reference group as non-infected and medium BMI [24–26 kg/m2] group): infected and the lowest BMI (≤20 kg/m2) group, hazard ratio (HR) 1.82 (95% confidence interval 1.51, 2.19); non-infected and the lowest BMI group, 1.39 (1.16, 1.67). When patients were stratified according to presence of diabetes mellitus (DM), patients with DM showed that low BMI was associated with the outcome both in infected and in non-infected patients, whereas in non-DM patients, this relationship was attenuated in the non-infected group. For emergently hospitalized CKD patients with infection, high BMI was associated with lower mortality irrespective of the DM status. For non-infected patients, the effects of obesity for in-hospital mortality were modified by the DM status.
Highlights
Chronic kidney disease (CKD) is associated with an increased risk of cardiovascular diseases and mortality [1]
Patients with a higher body mass index (BMI) were younger; were more likely to be males; were less likely to be transported by ambulance; were more likely to be treated by vasopressors; were less likely to have received a blood transfusion; were less likely to have received a central venous catheter insertion; had a higher prevalence of diabetes mellitus (DM), hypertension; and had a lower prevalence of anemia
In our study of emergently admitted dialysis-independent CKD (DI-CKD) patients, we demonstrated that the paradoxical association between higher BMI and better in-hospital mortality was seen both in infected and in non-infected patients, this association was relatively weaker in the non-infected patients
Summary
Chronic kidney disease (CKD) is associated with an increased risk of cardiovascular diseases and mortality [1]. Obesity is associated with higher mortality in the general population [2], this association is reversed in patients on dialysis [3,4], an effect called the “obesity.
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