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The Obesity Paradox and Mortality Associated With Surrogates of Body Size and Muscle Mass in Patients Receiving Hemodialysis

OBJECTIVE To determine whether dry weight gain accompanied by an increase in muscle mass is associated with a survival benefit in patients receiving maintenance hemodialysis (HD). PATIENTS AND METHODS In a nationally representative 5-year cohort of 121,762 patients receiving HD 3 times weekly from J... Full description

Journal Title: Mayo Clinic proceedings 2010, Vol.85 (11), p.991-1001
Main Author: Kalantar-Zadeh, Kamyar, MD, MPH, PhD
Other Authors: Streja, Elani, MPH , Kovesdy, Csaba P., MD , Oreopoulos, Antigone, PhD , Noori, Nazanin, MD, PhD , Jing, Jennie, MS , Nissenson, Allen R., MD , Krishnan, Mahesh, MD , Kopple, Joel D., MD , Mehrotra, Rajnish, MD , Anker, Stefan D., MD, PhD
Format: Electronic Article Electronic Article
Language: English
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Quelle: Alma/SFX Local Collection
Publisher: Rochester, MN: Elsevier Inc
ID: ISSN: 0025-6196
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recordid: cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_2966362
title: The Obesity Paradox and Mortality Associated With Surrogates of Body Size and Muscle Mass in Patients Receiving Hemodialysis
format: Article
creator:
  • Kalantar-Zadeh, Kamyar, MD, MPH, PhD
  • Streja, Elani, MPH
  • Kovesdy, Csaba P., MD
  • Oreopoulos, Antigone, PhD
  • Noori, Nazanin, MD, PhD
  • Jing, Jennie, MS
  • Nissenson, Allen R., MD
  • Krishnan, Mahesh, MD
  • Kopple, Joel D., MD
  • Mehrotra, Rajnish, MD
  • Anker, Stefan D., MD, PhD
subjects:
  • Abridged Index Medicus
  • Biological and medical sciences
  • Body Mass Index
  • Cohort Studies
  • Complications and side effects
  • Creatine - blood
  • Epidemiology
  • Female
  • General aspects
  • Health aspects
  • Hemodialysis patients
  • Humans
  • Internal Medicine
  • Kidney Failure, Chronic - blood
  • Kidney Failure, Chronic - mortality
  • Kidney Failure, Chronic - therapy
  • Male
  • Medical sciences
  • Metabolic diseases
  • Middle Aged
  • Muscle, Skeletal - anatomy & histology
  • Muscle, Skeletal - chemistry
  • Muscle, Skeletal - physiology
  • Obesity
  • Obesity - blood
  • Obesity - mortality
  • Original
  • Original Article
  • Proportional Hazards Models
  • Public health. Hygiene
  • Public health. Hygiene-occupational medicine
  • Renal Dialysis
  • Survival Analysis
  • Time Factors
  • Weight Gain
ispartof: Mayo Clinic proceedings, 2010, Vol.85 (11), p.991-1001
description: OBJECTIVE To determine whether dry weight gain accompanied by an increase in muscle mass is associated with a survival benefit in patients receiving maintenance hemodialysis (HD). PATIENTS AND METHODS In a nationally representative 5-year cohort of 121,762 patients receiving HD 3 times weekly from July 1, 2001, through June 30, 2006, we examined whether body mass index (BMI) (calculated using 3-month averaged post-HD dry weight) and 3-month averaged serum creatinine levels (a likely surrogate of muscle mass) and their changes over time were predictive of mortality risk. RESULTS In the cohort, higher BMI (up to 45) and higher serum creatinine concentration were incrementally and independently associated with greater survival, even after extensive multivariate adjustment for available surrogates of nutritional status and inflammation. Dry weight loss or gain over time exhibited a graded association with higher rates of mortality or survival, respectively, as did changes in serum creatinine level over time. Among the 50,831 patients who survived the first 6 months and who had available data for changes in weight and creatinine level, those who lost weight but had an increased serum creatinine level had a greater survival rate than those who gained weight but had a decreased creatinine level. These associations appeared consistent across different demographic groups of patients receiving HD. CONCLUSION In patients receiving long-term HD, larger body size with more muscle mass appears associated with a higher survival rate. A discordant muscle gain with weight loss over time may confer more survival benefit than weight gain while losing muscle. Controlled trials of muscle-gaining interventions in patients receiving HD are warranted.
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0025-6196
fulltext: fulltext
issn:
  • 0025-6196
  • 1942-5546
url: Link


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titleThe Obesity Paradox and Mortality Associated With Surrogates of Body Size and Muscle Mass in Patients Receiving Hemodialysis
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creatorKalantar-Zadeh, Kamyar, MD, MPH, PhD ; Streja, Elani, MPH ; Kovesdy, Csaba P., MD ; Oreopoulos, Antigone, PhD ; Noori, Nazanin, MD, PhD ; Jing, Jennie, MS ; Nissenson, Allen R., MD ; Krishnan, Mahesh, MD ; Kopple, Joel D., MD ; Mehrotra, Rajnish, MD ; Anker, Stefan D., MD, PhD
creatorcontribKalantar-Zadeh, Kamyar, MD, MPH, PhD ; Streja, Elani, MPH ; Kovesdy, Csaba P., MD ; Oreopoulos, Antigone, PhD ; Noori, Nazanin, MD, PhD ; Jing, Jennie, MS ; Nissenson, Allen R., MD ; Krishnan, Mahesh, MD ; Kopple, Joel D., MD ; Mehrotra, Rajnish, MD ; Anker, Stefan D., MD, PhD
descriptionOBJECTIVE To determine whether dry weight gain accompanied by an increase in muscle mass is associated with a survival benefit in patients receiving maintenance hemodialysis (HD). PATIENTS AND METHODS In a nationally representative 5-year cohort of 121,762 patients receiving HD 3 times weekly from July 1, 2001, through June 30, 2006, we examined whether body mass index (BMI) (calculated using 3-month averaged post-HD dry weight) and 3-month averaged serum creatinine levels (a likely surrogate of muscle mass) and their changes over time were predictive of mortality risk. RESULTS In the cohort, higher BMI (up to 45) and higher serum creatinine concentration were incrementally and independently associated with greater survival, even after extensive multivariate adjustment for available surrogates of nutritional status and inflammation. Dry weight loss or gain over time exhibited a graded association with higher rates of mortality or survival, respectively, as did changes in serum creatinine level over time. Among the 50,831 patients who survived the first 6 months and who had available data for changes in weight and creatinine level, those who lost weight but had an increased serum creatinine level had a greater survival rate than those who gained weight but had a decreased creatinine level. These associations appeared consistent across different demographic groups of patients receiving HD. CONCLUSION In patients receiving long-term HD, larger body size with more muscle mass appears associated with a higher survival rate. A discordant muscle gain with weight loss over time may confer more survival benefit than weight gain while losing muscle. Controlled trials of muscle-gaining interventions in patients receiving HD are warranted.
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subjectAbridged Index Medicus ; Biological and medical sciences ; Body Mass Index ; Cohort Studies ; Complications and side effects ; Creatine - blood ; Epidemiology ; Female ; General aspects ; Health aspects ; Hemodialysis patients ; Humans ; Internal Medicine ; Kidney Failure, Chronic - blood ; Kidney Failure, Chronic - mortality ; Kidney Failure, Chronic - therapy ; Male ; Medical sciences ; Metabolic diseases ; Middle Aged ; Muscle, Skeletal - anatomy & histology ; Muscle, Skeletal - chemistry ; Muscle, Skeletal - physiology ; Obesity ; Obesity - blood ; Obesity - mortality ; Original ; Original Article ; Proportional Hazards Models ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Renal Dialysis ; Survival Analysis ; Time Factors ; Weight Gain
ispartofMayo Clinic proceedings, 2010, Vol.85 (11), p.991-1001
rights
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6Nissenson, Allen R., MD
7Krishnan, Mahesh, MD
8Kopple, Joel D., MD
9Mehrotra, Rajnish, MD
10Anker, Stefan D., MD, PhD
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0The Obesity Paradox and Mortality Associated With Surrogates of Body Size and Muscle Mass in Patients Receiving Hemodialysis
1Mayo Clinic proceedings
addtitleMayo Clin Proc
descriptionOBJECTIVE To determine whether dry weight gain accompanied by an increase in muscle mass is associated with a survival benefit in patients receiving maintenance hemodialysis (HD). PATIENTS AND METHODS In a nationally representative 5-year cohort of 121,762 patients receiving HD 3 times weekly from July 1, 2001, through June 30, 2006, we examined whether body mass index (BMI) (calculated using 3-month averaged post-HD dry weight) and 3-month averaged serum creatinine levels (a likely surrogate of muscle mass) and their changes over time were predictive of mortality risk. RESULTS In the cohort, higher BMI (up to 45) and higher serum creatinine concentration were incrementally and independently associated with greater survival, even after extensive multivariate adjustment for available surrogates of nutritional status and inflammation. Dry weight loss or gain over time exhibited a graded association with higher rates of mortality or survival, respectively, as did changes in serum creatinine level over time. Among the 50,831 patients who survived the first 6 months and who had available data for changes in weight and creatinine level, those who lost weight but had an increased serum creatinine level had a greater survival rate than those who gained weight but had a decreased creatinine level. These associations appeared consistent across different demographic groups of patients receiving HD. CONCLUSION In patients receiving long-term HD, larger body size with more muscle mass appears associated with a higher survival rate. A discordant muscle gain with weight loss over time may confer more survival benefit than weight gain while losing muscle. Controlled trials of muscle-gaining interventions in patients receiving HD are warranted.
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28Proportional Hazards Models
29Public health. Hygiene
30Public health. Hygiene-occupational medicine
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32Survival Analysis
33Time Factors
34Weight Gain
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titleThe Obesity Paradox and Mortality Associated With Surrogates of Body Size and Muscle Mass in Patients Receiving Hemodialysis
authorKalantar-Zadeh, Kamyar, MD, MPH, PhD ; Streja, Elani, MPH ; Kovesdy, Csaba P., MD ; Oreopoulos, Antigone, PhD ; Noori, Nazanin, MD, PhD ; Jing, Jennie, MS ; Nissenson, Allen R., MD ; Krishnan, Mahesh, MD ; Kopple, Joel D., MD ; Mehrotra, Rajnish, MD ; Anker, Stefan D., MD, PhD
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1Biological and medical sciences
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3Cohort Studies
4Complications and side effects
5Creatine - blood
6Epidemiology
7Female
8General aspects
9Health aspects
10Hemodialysis patients
11Humans
12Internal Medicine
13Kidney Failure, Chronic - blood
14Kidney Failure, Chronic - mortality
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16Male
17Medical sciences
18Metabolic diseases
19Middle Aged
20Muscle, Skeletal - anatomy & histology
21Muscle, Skeletal - chemistry
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23Obesity
24Obesity - blood
25Obesity - mortality
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29Public health. Hygiene
30Public health. Hygiene-occupational medicine
31Renal Dialysis
32Survival Analysis
33Time Factors
34Weight Gain
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5Jing, Jennie, MS
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0We thank Mr Robert Lehn at DaVita Laboratories in Deland, FL, and Mr Joe Weldon, from DaVita Informatics, for providing the national database, and Mr Chris Rucker and Ms Beth Bennett from DaVita Clinical Research for their continued support.
1The study was supported by Dr Kalantar-Zadeh's research grants from the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health (R01 DK078106), the American Heart Association (0655776Y), and Davita Clinical Research (DCR), as well as a philanthropic grant from Mr Harold Simmons and an additional DCR grant for the Division of Nephrology & Hypertension at Harbor-UCLA Medical Center.
2Drs Nissenson and Krishnan are employees of DaVita. Dr Kalantar-Zadeh is the medical director of the DaVita Harbor-UCLA/MFI Chronic Dialysis Center in Long Beach, CA.
abstractOBJECTIVE To determine whether dry weight gain accompanied by an increase in muscle mass is associated with a survival benefit in patients receiving maintenance hemodialysis (HD). PATIENTS AND METHODS In a nationally representative 5-year cohort of 121,762 patients receiving HD 3 times weekly from July 1, 2001, through June 30, 2006, we examined whether body mass index (BMI) (calculated using 3-month averaged post-HD dry weight) and 3-month averaged serum creatinine levels (a likely surrogate of muscle mass) and their changes over time were predictive of mortality risk. RESULTS In the cohort, higher BMI (up to 45) and higher serum creatinine concentration were incrementally and independently associated with greater survival, even after extensive multivariate adjustment for available surrogates of nutritional status and inflammation. Dry weight loss or gain over time exhibited a graded association with higher rates of mortality or survival, respectively, as did changes in serum creatinine level over time. Among the 50,831 patients who survived the first 6 months and who had available data for changes in weight and creatinine level, those who lost weight but had an increased serum creatinine level had a greater survival rate than those who gained weight but had a decreased creatinine level. These associations appeared consistent across different demographic groups of patients receiving HD. CONCLUSION In patients receiving long-term HD, larger body size with more muscle mass appears associated with a higher survival rate. A discordant muscle gain with weight loss over time may confer more survival benefit than weight gain while losing muscle. Controlled trials of muscle-gaining interventions in patients receiving HD are warranted.
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