Tae Ik Chang1,2, Vyvian Ngo1, Elani Streja1,3, Jason A Chou1, Amanda R Tortorici1, Tae Hee Kim1,4, Tae Woo Kim1,5, Melissa Soohoo1, Daniel Gillen1, Connie M Rhee1, Csaba P Kovesdy6,7, Kamyar Kalantar-Zadeh1,3. 1. Division of Nephrology & Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA. 2. Department of Internal Medicine, NHIS Medical Center, Ilsan Hospital, Goyangshi, Gyeonggi-do, Republic of Korea. 3. Department of Medicine, Long Beach Veteran Affairs Health System, Long Beach, CA, USA. 4. Department of Internal Medicine, Inje University, Busan, Republic of Korea. 5. Department of Internal Medicine, Soon Chun Hyang University Hospital, Gumi, Republic of Korea. 6. Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA. 7. Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, TN, USA.
Abstract
BACKGROUND: Incident hemodialysis patients may experience rapid weight loss in the first few months of starting dialysis. However, trends in weight changes over time and their associations with survival have not yet been characterized in this population. METHODS: In a large contemporary US cohort of 58 106 patients who initiated hemodialysis during 1 January 2007-31 December 2011 and survived the first year of dialysis, we observed trends in weight changes during the first year of treatment and then examined the association of post-dialysis weight changes with all-cause mortality. RESULTS: Patients' post-dialysis weights rapidly decreased and reached a nadir at the 5th month of dialysis with an average decline of 2% from baseline, whereas obese patients (body mass index ≥30 kg/m 2 ) did not reach a nadir and lost ∼3.8% of their weight by the 12th month. Compared with the reference group (-2 to 2% changes in weight), the death hazard ratios (HRs) of patients with -6 to -2% and greater than or equal to -6% weight loss during the first 5 months were 1.08 (95% confidence interval, 1.02-1.14) and 1.14 (1.07-1.22), respectively. Moreover, the death HRs with 2-6% and ≥6% weight gain during the 5th to 12th months were 0.91 (0.85-0.97) and 0.92 (0.86-0.99), respectively. CONCLUSIONS: In patients who survive the first year of hemodialysis, a decline in post-dialysis weight is observed and reaches a nadir at the 5th month. An incrementally larger weight loss during the first 12 months is associated with higher death risk, whereas weight gain is associated with greater survival during the 5th to 12th month but not in the first 5 months of dialysis therapy.
BACKGROUND: Incident hemodialysis patients may experience rapid weight loss in the first few months of starting dialysis. However, trends in weight changes over time and their associations with survival have not yet been characterized in this population. METHODS: In a large contemporary US cohort of 58 106 patients who initiated hemodialysis during 1 January 2007-31 December 2011 and survived the first year of dialysis, we observed trends in weight changes during the first year of treatment and then examined the association of post-dialysis weight changes with all-cause mortality. RESULTS: Patients' post-dialysis weights rapidly decreased and reached a nadir at the 5th month of dialysis with an average decline of 2% from baseline, whereas obese patients (body mass index ≥30 kg/m 2 ) did not reach a nadir and lost ∼3.8% of their weight by the 12th month. Compared with the reference group (-2 to 2% changes in weight), the death hazard ratios (HRs) of patients with -6 to -2% and greater than or equal to -6% weight loss during the first 5 months were 1.08 (95% confidence interval, 1.02-1.14) and 1.14 (1.07-1.22), respectively. Moreover, the death HRs with 2-6% and ≥6% weight gain during the 5th to 12th months were 0.91 (0.85-0.97) and 0.92 (0.86-0.99), respectively. CONCLUSIONS: In patients who survive the first year of hemodialysis, a decline in post-dialysis weight is observed and reaches a nadir at the 5th month. An incrementally larger weight loss during the first 12 months is associated with higher death risk, whereas weight gain is associated with greater survival during the 5th to 12th month but not in the first 5 months of dialysis therapy.
Authors: Kamyar Kalantar-Zadeh; Elani Streja; Csaba P Kovesdy; Antigone Oreopoulos; Nazanin Noori; Jennie Jing; Allen R Nissenson; Mahesh Krishnan; Joel D Kopple; Rajnish Mehrotra; Stefan D Anker Journal: Mayo Clin Proc Date: 2010-11 Impact factor: 7.616
Authors: Iván Cabezas-Rodriguez; Juan Jesús Carrero; Carmine Zoccali; Abdul Rashid Qureshi; Markus Ketteler; Jürgen Floege; Gérard London; Francesco Locatelli; José Luis Gorriz; Boleslaw Rutkowski; Dimitrios Memmos; Anibal Ferreira; Adrian Covic; Vladimir Teplan; Willem-Jan Bos; Reinhard Kramar; Drasko Pavlovic; David Goldsmith; Judit Nagy; Miha Benedik; Dierik Verbeelen; Christian Tielemans; Rudolf P Wüthrich; Pierre-Yves Martin; Carlos Martínez-Salgado; José Luis Fernández-Martín; Jorge B Cannata-Andia Journal: Clin J Am Soc Nephrol Date: 2013-09-05 Impact factor: 8.237
Authors: Kamyar Kalantar-Zadeh; Joel D Kopple; Ryan D Kilpatrick; Charles J McAllister; Christian S Shinaberger; David W Gjertson; Sander Greenland Journal: Am J Kidney Dis Date: 2005-09 Impact factor: 8.860
Authors: Kamyar Kalantar-Zadeh; Kevin C Abbott; Abdulla K Salahudeen; Ryan D Kilpatrick; Tamara B Horwich Journal: Am J Clin Nutr Date: 2005-03 Impact factor: 7.045
Authors: Kevin C Abbott; Christopher W Glanton; Fernando C Trespalacios; David K Oliver; Maria I Ortiz; Lawrence Y Agodoa; David F Cruess; Paul L Kimmel Journal: Kidney Int Date: 2004-02 Impact factor: 10.612
Authors: Matthew J Roberts; Mark M Mitsnefes; Charles E McCulloch; Larry A Greenbaum; Barbara A Grimes; Elaine Ku Journal: Pediatr Nephrol Date: 2019-04-08 Impact factor: 3.714
Authors: Nazanin Noori; Andrew T Yan; Mercedeh Kiaii; Andrea Rathe; Marc B Goldstein; Olugbenga Bello; Ron Wald Journal: Int Urol Nephrol Date: 2017-04-29 Impact factor: 2.370
Authors: Meera Nair Harhay; Karthik Ranganna; Suzanne M Boyle; Antonia M Brown; Thalia Bajakian; Lissa B Levin Mizrahi; Gary Xiao; Stephen Guy; Gregory Malat; Dorry L Segev; David Reich; Mara McAdams-DeMarco Journal: Am J Kidney Dis Date: 2019-05-21 Impact factor: 8.860
Authors: Sean Cai; Ron Wald; Djeven P Deva; Mercedeh Kiaii; Ming-Yen Ng; Gauri R Karur; Oblugbenga Bello; Zhuo Jun Li; Jonathon Leipsic; Laura Jimenez-Juan; Anish Kirpalani; Kim A Connelly; Andrew T Yan Journal: J Nephrol Date: 2019-11-14 Impact factor: 3.902
Authors: Kamyar Kalantar-Zadeh; Connie M Rhee; Jason Chou; S Foad Ahmadi; Jongha Park; Joline Lt Chen; Alpesh N Amin Journal: Kidney Int Rep Date: 2017-02-01