Cédric Villain1, René Ecochard2, Leslie Genet3, Guillaume Jean4, François Kuentz5, Dominique Lataillade6, Eric Legrand7, Xavier Moreau-Gaudry8, Denis Fouque9. 1. Service de Biostatistique, Hospices Civils de Lyon, Lyon, France; Université de Lyon, Lyon, France; Université Lyon 1, Villeurbanne, France; CNRS, UMR5558, Equipe Biostatistique-Santé, Villeurbanne, France; Service de néphrologie-nutrition-dialyse, Centre Hospitalier Lyon Sud, Lyon, France. Electronic address: cedric.villain@chu-lyon.fr. 2. Service de Biostatistique, Hospices Civils de Lyon, Lyon, France; Université de Lyon, Lyon, France; Université Lyon 1, Villeurbanne, France; CNRS, UMR5558, Equipe Biostatistique-Santé, Villeurbanne, France. 3. Service de néphrologie-nutrition-dialyse, Centre Hospitalier Lyon Sud, Lyon, France. 4. NephroCare Tassin-Charcot, Sainte-Foy-lès-Lyon, France. 5. Centre de Dialyse des Eaux Claires, AGDUC, Grenoble, France. 6. Service de Néphrologie, Clinique Edouard Rist, Paris, France. 7. Service de Néphrologie et Hémodialyse, Centre Hospitalier d'Ardèche Nord, Annonay, France. 8. Centre de Dialyse, Centre Hospitalier Général, AGDUC, Montélimar, France. 9. Université de Lyon, Lyon, France; Université Lyon 1, Villeurbanne, France; Service de néphrologie-nutrition-dialyse, Centre Hospitalier Lyon Sud, Lyon, France; INSERM CarMeN, CENS, Université Lyon 1, Villeurbanne, France.
Abstract
OBJECTIVES: In elderly hemodialysis patients, protein-energy wasting is associated with poor outcome; however, the association between body mass index (BMI) changes over time, and survival has been seldom studied in this particularly frail population. DESIGN AND METHODS: This prospective study recruited 502 hemodialysis patients aged ≥75 years from the French cohort ARNOS and followed them from 2005 to 2009. BMI changes over time were modeled by individual linear regression models. Survival analyses used frailty Cox models. RESULTS: The population average age was 80.9 years. Forty-one percent of the patients died during follow-up. A 1 kg/m(2) lower baseline BMI was associated with a 4% increase in the risk of death over the study period (hazard ratio [HR] 1.04, 95% confidence interval [1.01-1.08], P = .02). A 5% BMI loss per year was associated with a 52% increase in the risk of death (HR 1.52, 95% confidence interval [1.32-1.75], P < .001). In patients who lost weight (>5% BMI loss per year), the lower was the baseline BMI, the higher was the HR for death. There was a similar trend in the patients with stable weight (5% BMI loss-5% BMI gain per year). In patients who gained weight, the HR was unexpectedly higher than in those with stable weight. CONCLUSIONS: In elderly hemodialysis patients, the impact of the BMI percent change on survival was stronger than that of the baseline BMI. Patients with stable weight had longer survivals than patients who lost or gained weight. Thus, in this population, BMI changes should be regularly assessed. Further studies should assess the safety of weight gain strategies.
OBJECTIVES: In elderly hemodialysis patients, protein-energy wasting is associated with poor outcome; however, the association between body mass index (BMI) changes over time, and survival has been seldom studied in this particularly frail population. DESIGN AND METHODS: This prospective study recruited 502 hemodialysis patients aged ≥75 years from the French cohort ARNOS and followed them from 2005 to 2009. BMI changes over time were modeled by individual linear regression models. Survival analyses used frailty Cox models. RESULTS: The population average age was 80.9 years. Forty-one percent of the patients died during follow-up. A 1 kg/m(2) lower baseline BMI was associated with a 4% increase in the risk of death over the study period (hazard ratio [HR] 1.04, 95% confidence interval [1.01-1.08], P = .02). A 5% BMI loss per year was associated with a 52% increase in the risk of death (HR 1.52, 95% confidence interval [1.32-1.75], P < .001). In patients who lost weight (>5% BMI loss per year), the lower was the baseline BMI, the higher was the HR for death. There was a similar trend in the patients with stable weight (5% BMI loss-5% BMI gain per year). In patients who gained weight, the HR was unexpectedly higher than in those with stable weight. CONCLUSIONS: In elderly hemodialysis patients, the impact of the BMI percent change on survival was stronger than that of the baseline BMI. Patients with stable weight had longer survivals than patients who lost or gained weight. Thus, in this population, BMI changes should be regularly assessed. Further studies should assess the safety of weight gain strategies.
Authors: Joanne Reid; Helen R Noble; Gary Adamson; Andrew Davenport; Ken Farrington; Denis Fouque; Kamyar Kalantar-Zadeh; John Mallett; C McKeaveney; S Porter; David S Seres; Joanne Shields; Adrian Slee; Miles D Witham; Alexander P Maxwell Journal: BMC Nephrol Date: 2018-02-13 Impact factor: 2.388