Elaine Ku1, Joel D Kopple2, Kirsten L Johansen3, Charles E McCulloch4, Alan S Go5, Dawei Xie6, Feng Lin4, L Lee Hamm7, Jiang He8, John W Kusek9, Sankar D Navaneethan10, Ana C Ricardo11, Hernan Rincon-Choles12, Miroslaw Smogorzewski13, Chi-Yuan Hsu14. 1. Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, CA; Division of Pediatric Nephrology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA. Electronic address: elaine.ku@ucsf.edu. 2. Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, and University of California, Los Angeles Schools of Medicine and Public Health, Los Angeles, CA. 3. Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, CA; Nephrology Section, San Francisco Veterans Affairs Medical Center, San Francisco, CA. 4. Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA. 5. Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA; Division of Research, Kaiser Permanente Northern California, Oakland, CA. 6. Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 7. Department of Medicine, Tulane University School of Medicine, New Orleans, LA. 8. Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA. 9. National Institute of Diabetes, Digestive, and Kidney Diseases, National Institutes of Health, Bethesda, MD. 10. Section of Nephrology, Baylor College of Medicine, Houston, TX. 11. Division of Nephrology, Department of Medicine, University of Illinois, Chicago, IL. 12. Glickman Urological and Kidney Institute, Department of Nephrology, Cleveland Clinic Foundation, Cleveland, OH. 13. Department of Medicine, University of Southern California, Los Angeles, CA. 14. Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, CA.
Abstract
BACKGROUND: Few studies have investigated the changes in weight that may occur over time among adults with the progression of chronic kidney disease (CKD). Whether such weight changes are independently associated with death after the onset of end-stage renal disease has also not been rigorously examined. STUDY DESIGN: Prospective cohort study. SETTING & PARTICIPANTS: We studied 3,933 participants of the Chronic Renal Insufficiency Cohort (CRIC) Study, a longitudinal cohort of patients with CKD. We also performed similar analyses among 1,067 participants of the African American Study of Kidney Disease and Hypertension (AASK). PREDICTORS: Estimated glomerular filtration rate (eGFR) and weight change during CKD. OUTCOME: Weight and all-cause mortality after dialysis therapy initiation. RESULTS: During a median follow-up of 5.7 years in CRIC, weight change was not linear. Weight was stable until cystatin C-based eGFR (eGFRcys) decreased to <35mL/min/1.73m2; thereafter, weight declined at a mean rate of 1.45 kg (95% CI, 1.19-1.70) for every 10 mL/min/1.73m2 decline in eGFRcys. Among the 770 CRIC participants who began hemodialysis or peritoneal dialysis therapy during follow-up, a >5% annualized weight loss after eGFR decreased to <35mL/min/1.73m2 was associated with a 54% higher risk for death after dialysis therapy initiation (95% CI, 1.17-2.03) compared with those with more stable weight (annualized weight changes within 5% of baseline) in adjusted analysis. Similar findings were observed in the AASK. LIMITATIONS: Inclusion of research participants only; inability to distinguish intentional versus unintentional weight loss. CONCLUSIONS: Significant weight loss began relatively early during the course of CKD and was associated with a substantially higher risk for death after dialysis therapy initiation. Further studies are needed to determine whether interventions to optimize weight and nutritional status before the initiation of dialysis therapy will improve outcomes after end-stage renal disease.
BACKGROUND: Few studies have investigated the changes in weight that may occur over time among adults with the progression of chronic kidney disease (CKD). Whether such weight changes are independently associated with death after the onset of end-stage renal disease has also not been rigorously examined. STUDY DESIGN: Prospective cohort study. SETTING & PARTICIPANTS: We studied 3,933 participants of the Chronic Renal Insufficiency Cohort (CRIC) Study, a longitudinal cohort of patients with CKD. We also performed similar analyses among 1,067 participants of the African American Study of Kidney Disease and Hypertension (AASK). PREDICTORS: Estimated glomerular filtration rate (eGFR) and weight change during CKD. OUTCOME: Weight and all-cause mortality after dialysis therapy initiation. RESULTS: During a median follow-up of 5.7 years in CRIC, weight change was not linear. Weight was stable until cystatin C-based eGFR (eGFRcys) decreased to <35mL/min/1.73m2; thereafter, weight declined at a mean rate of 1.45 kg (95% CI, 1.19-1.70) for every 10 mL/min/1.73m2 decline in eGFRcys. Among the 770 CRIC participants who began hemodialysis or peritoneal dialysis therapy during follow-up, a >5% annualized weight loss after eGFR decreased to <35mL/min/1.73m2 was associated with a 54% higher risk for death after dialysis therapy initiation (95% CI, 1.17-2.03) compared with those with more stable weight (annualized weight changes within 5% of baseline) in adjusted analysis. Similar findings were observed in the AASK. LIMITATIONS: Inclusion of research participants only; inability to distinguish intentional versus unintentional weight loss. CONCLUSIONS: Significant weight loss began relatively early during the course of CKD and was associated with a substantially higher risk for death after dialysis therapy initiation. Further studies are needed to determine whether interventions to optimize weight and nutritional status before the initiation of dialysis therapy will improve outcomes after end-stage renal disease.
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