BACKGROUND: 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. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: 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. PREDICTORS: Race and BMI. OUTCOMES: All-cause mortality. RESULTS: 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. LIMITATIONS: Race and ethnicity categories were based on self-identified data. CONCLUSIONS: 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.
BACKGROUND: In maintenance hemodialysis (HD) patients, overweight and obesity are associated with survival advantages. Given the greater survival of maintenance HDpatients 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. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: We examined a 6-year (2001-2007) cohort of 109,605 maintenance HDpatients 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. PREDICTORS: Race and BMI. OUTCOMES: All-cause mortality. RESULTS: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 HDpatients showed the largest consistent decrease in death HR with increasing BMI. LIMITATIONS: Race and ethnicity categories were based on self-identified data. CONCLUSIONS: Whereas the survival advantage of high BMI is consistent across all racial/ethnic groups, black maintenance HDpatients had the strongest and most consistent association of higher BMI with improved survival.
Authors: Vanessa A Ravel; Miklos Z Molnar; Elani Streja; Jun Chul Kim; Alla Victoroff; Jennie Jing; Debbie Benner; Keith C Norris; Csaba P Kovesdy; Joel D Kopple; Kamyar Kalantar-Zadeh Journal: J Nutr Date: 2013-05-22 Impact factor: 4.798
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