Abstract
ObjectivesTo study the body mass index (BMI) trajectory in patients with incident end-stage kidney disease and its association with all-cause mortality.MethodsThis longitudinal cohort study included 17022 adult patients commencing hemodialysis [HD] (n = 10860) or peritoneal dialysis [PD] (n = 6162) between 2001 and 2008 and had ≥6-month follow-up and ≥2 weight measurements, using the Australia and New Zealand Dialysis and Transplant Registry data. The association of time-varying BMI with all-cause mortality was explored using multivariate Cox regression models.ResultsThe median follow-up was 2.3 years. There was a non-linear change in the mean BMI (kg/m2) over time, with an initial decrease from 27.6 (95% confidence interval [CI]: 27.5, 27.7) to 26.7 (95% CI: 26.6, 26.9) at 3-month, followed by increments to 27.1 (95% CI: 27, 27.2) at 1-year and 27.2 (95% CI: 26.8, 27.1) at 3-year, and a gradual decrease subsequently. The BMI trajectory was significantly lower in HD patients who died than those who survived, although this pattern was not observed in PD patients. Compared to the reference time-varying BMI category of 25.1–28 kg/m2, the mortality risks of both HD and PD patients were greater in all categories of time-varying BMI <25 kg/m2. The mortality risks were significantly lower in all categories of time-varying BMI >28.1 kg/m2 among HD patients, but only in the category 28.1–31 kg/m2 among PD patients.ConclusionsBMI changed over time in a non-linear fashion in incident dialysis patients. Time-varying measures of BMI were significantly associated with mortality risk in both HD and PD patients.
Highlights
Two-thirds of the adult population in developed countries is either overweight or obese, defined as body-mass index (BMI) $25 kg/m2 [1, 2]
BMI changed over time in a non-linear fashion in incident dialysis patients
Time-varying measures of BMI were significantly associated with mortality risk in both HD and peritoneal dialysis (PD) patients
Summary
Two-thirds of the adult population in developed countries is either overweight or obese, defined as body-mass index (BMI) $25 kg/m2 [1, 2]. The association between obesity and survival is less clear in ESKD patients receiving peritoneal dialysis (PD), with studies variably showing better [16, 17], comparable [11, 18, 19], or worse [14, 20] survival. Due to this conflicting evidence, except for severely obese patients who are waiting for kidney transplant surgery, it is largely unclear whether to recommend weight loss therapy to dialysis patients who are either overweight or obese. We examined the BMI trajectory and its association with all-cause mortality in incident ESKD patients on both HD and PD using data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry
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