2007 JASN IMPACT FACTOR 7.111	HOME   AUTHOR INFO   EDITORIAL BOARD   SUBSCRIBE   FEEDBACK   ALERTS   HELP
advanced	CURRENT ISSUE	ARCHIVES	JASN Express	ONLINE SUBMISSION

This Article Full Text Full Text (PDF) All Versions of this Article: ASN.2006091050v1 18/3/967    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by de Mutsert, R. Search for Related Content PubMed PubMed Citation Articles by de Mutsert, R.

Association between Body Mass Index and Mortality Is Similar in the Hemodialysis Population and the General Population at High Age and Equal Duration of Follow-Up

Renée de Mutsert^*, Marieke B. Snijder^,, Femke van der Sman-de Beer^*, Jacob C. Seidell, Elisabeth W. Boeschoten, Raymond T. Krediet^||, Jacqueline M. Dekker, Jan P. Vandenbroucke^*, Friedo W. Dekker^* for the Netherlands Cooperative Study on the Adequacy of Dialysis-2 (NECOSAD) Study Group

^* Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Institute of Health Sciences, Department of Nutrition and Health, Vrÿe Universiteit Medical Center, EMGO Institute, Vrÿe Universiteit Medical Center, and ^|| Department of Nephrology, Academic Medical Center, Amsterdam, and Hans Mak Institute, Naarden, The Netherlands

Address correspondence to: Renée de Mutsert, MSc, Leiden University Medical Center, Department of Clinical Epidemiology, PO Box 9600, 2300 RC Leiden, The Netherlands. Phone: +31-71-526-6534; Fax: +31-71-526-6994; E-mail: r.de_mutsert{at}lumc.nl

Received for publication September 25, 2006. Accepted for publication December 29, 2006.

The association of body mass index (BMI) with mortality in hemodialysis patients has been found to be reversed in comparison with the general population. This study examined the association of BMI with mortality in the hemodialysis population and the general population when age and time of follow-up were made strictly comparable. Hemodialysis patients who were aged 50 to 75 yr at the start of follow-up were selected from the Netherlands Cooperative Study on the Adequacy of Dialysis-2 (NECOSAD), a prospective cohort study in incident dialysis patients in the Netherlands (n = 722; age 66 ± 7 yr; BMI 25.3 ± 4.5 kg/m²), and compared with adults who were aged 50 to 75 yr and included in the Hoorn Study, a population-based prospective cohort study in the same country (n = 2436; age 62 ± 7 yr; BMI 26.5 ± 3.6 kg/m²). In both populations, 2- and 7-yr standardized mortality rates were calculated for categories of BMI. Adjusted hazard ratios (HR) of BMI categories were calculated with a BMI of 22.5 to 25 kg/m² as the reference category within each population. In 7 yr of follow-up, standardized mortality rates were approximately 10 times higher in the hemodialysis population than those in the general population. Compared with the reference category, the HR of BMI <18.5 kg/m² was 2.0 (95% confidence interval [CI]1.2 to 3.4) in the hemodialysis population and 2.3 (95% CI 0.7 to 7.5) in the general population. Obesity (BMI 30 kg/m²) was associated with a HR of 1.2 (95% CI 0.8 to 1.7) in the hemodialysis population and 1.3 (95% CI 0.9 to 2.0) in the general population. In conclusion, a hemodialysis population and a general population with comparable age and equal duration of follow-up showed similar mortality risk patterns associated with BMI. This suggests that there is no reverse epidemiology of BMI and mortality in hemodialysis patients. The clinical implication of this study is that to improve survival in the hemodialysis population, more attention should be paid to patients who are underweight instead of overweight.

This article has been cited by other articles:

				C. Zoccali The obesity epidemics in ESRD: from wasting to waist? Nephrol. Dial. Transplant., October 24, 2008; (2008) gfn589v1. [Full Text] [PDF]

				D. Mafra, F. Guebre-Egziabher, and D. Fouque Body mass index, muscle and fat in chronic kidney disease: questions about survival Nephrol. Dial. Transplant., August 1, 2008; 23(8): 2461 - 2466. [Abstract] [Full Text] [PDF]

				T. A. Ikizler, P. Stenvinkel, and B. Lindholm Resolved: Being Fat Is Good for Dialysis Patients: The Godzilla Effect: Pro J. Am. Soc. Nephrol., June 1, 2008; 19(6): 1059 - 1064. [Abstract] [Full Text] [PDF]

				P. Stenvinkel, J. J. Carrero, J. Axelsson, B. Lindholm, O. Heimburger, and Z. Massy Emerging Biomarkers for Evaluating Cardiovascular Risk in the Chronic Kidney Disease Patient: How Do New Pieces Fit into the Uremic Puzzle? Clin. J. Am. Soc. Nephrol., March 1, 2008; 3(2): 505 - 521. [Abstract] [Full Text] [PDF]

				A. S. Kliger Frequent Nocturnal Hemodialysis A Step Forward? JAMA, September 19, 2007; 298(11): 1331 - 1333. [Full Text] [PDF]

				E. Villar, L. Remontet, M. Labeeuw, R. Ecochard, and on behalf of the Association Regionale des Nephrol Effect of Age, Gender, and Diabetes on Excess Death in End-Stage Renal Failure J. Am. Soc. Nephrol., July 1, 2007; 18(7): 2125 - 2134. [Abstract] [Full Text] [PDF]

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673