BACKGROUND: Larger body size is associated with greater survival in maintenance hemodialysis (MHD) patients. It is not clear how lean body mass (LBM) and fat mass (FM) compare in their associations with survival across sex in these patients. OBJECTIVE: We examined the hypothesis that higher FM and LBM are associated with greater survival in MHD patents irrespective of sex. DESIGN: In 742 MHD patients, including 31% African Americans with a mean (± SD) age of 54 ± 15 y, we categorized men (n = 391) and women (n = 351) separately into 4 quartiles of near-infrared interactance-measured LBM and FM. Cox proportional hazards models estimated death hazard ratios (HRs) (and 95% CIs), and cubic spline models were used to examine associations with mortality over 5 y (2001-2006). RESULTS: After adjustment for case-mix and inflammatory markers, the highest quartiles of FM and LBM were associated with greater survival in women: HRs of 0.38 (95% CI: 0.20, 0.71) and 0.34 (95% CI: 0.17, 0.67), respectively (reference: first quartile). In men, the highest quartiles of FM and percentage FM (FM%) but not of LBM were associated with greater survival: HRs of 0.51 (95% CI: 0.27, 0.96), 0.45 (95% CI: 0.23, 0.88), and 1.17 (95% CI: 0.60, 2.27), respectively. Cubic spline analyses showed greater survival with higher FM% and higher "FM minus LBM percentiles" in both sexes, whereas a higher LBM was protective in women. CONCLUSIONS: In MHD patients, higher FM in both sexes and higher LBM in women appear to be protective. The survival advantage of FM appears to be superior to that of LBM. Clinical trials to examine the outcomes of interventions that modify body composition in MHD patients are indicated.
BACKGROUND: Larger body size is associated with greater survival in maintenance hemodialysis (MHD) patients. It is not clear how lean body mass (LBM) and fat mass (FM) compare in their associations with survival across sex in these patients. OBJECTIVE: We examined the hypothesis that higher FM and LBM are associated with greater survival in MHD patents irrespective of sex. DESIGN: In 742 MHD patients, including 31% African Americans with a mean (± SD) age of 54 ± 15 y, we categorized men (n = 391) and women (n = 351) separately into 4 quartiles of near-infrared interactance-measured LBM and FM. Cox proportional hazards models estimated death hazard ratios (HRs) (and 95% CIs), and cubic spline models were used to examine associations with mortality over 5 y (2001-2006). RESULTS: After adjustment for case-mix and inflammatory markers, the highest quartiles of FM and LBM were associated with greater survival in women: HRs of 0.38 (95% CI: 0.20, 0.71) and 0.34 (95% CI: 0.17, 0.67), respectively (reference: first quartile). In men, the highest quartiles of FM and percentage FM (FM%) but not of LBM were associated with greater survival: HRs of 0.51 (95% CI: 0.27, 0.96), 0.45 (95% CI: 0.23, 0.88), and 1.17 (95% CI: 0.60, 2.27), respectively. Cubic spline analyses showed greater survival with higher FM% and higher "FM minus LBM percentiles" in both sexes, whereas a higher LBM was protective in women. CONCLUSIONS: In MHD patients, higher FM in both sexes and higher LBM in women appear to be protective. The survival advantage of FM appears to be superior to that of LBM. Clinical trials to examine the outcomes of interventions that modify body composition in MHD patients are indicated.
Authors: Miklos Z Molnar; Elani Streja; Csaba P Kovesdy; Matthew J Budoff; Allen R Nissenson; Mahesh Krishnan; Stefan D Anker; Keith C Norris; Gregg C Fonarow; Kamyar Kalantar-Zadeh Journal: Am J Clin Nutr Date: 2011-08-03 Impact factor: 7.045
Authors: Nazanin Noori; Csaba P Kovesdy; Ramanath Dukkipati; Usama Feroze; Miklos Z Molnar; Rachelle Bross; Allen R Nissenson; Joel D Kopple; Keith C Norris; Kamyar Kalantar-Zadeh Journal: Am J Nephrol Date: 2011-02-04 Impact factor: 3.754
Authors: Jialin Wang; Elani Streja; Connie M Rhee; Melissa Soohoo; Mingliang Feng; Steven M Brunelli; Csaba P Kovesdy; Daniel Gillen; Kamyar Kalantar-Zadeh; Joline L T Chen Journal: J Ren Nutr Date: 2015-10-21 Impact factor: 3.655