Association of Abdominal Adiposity with Cardiovascular Mortality in Incident Hemodialysis

Jessica Fitzpatrick, Stephen M Sozio, Bernard Jaar, Mara Ann McAdams Demarco, Michelle M. Estrella, Larisa G. Tereshchenko, Jose Monroy-Trujillo, Rulan S. Parekh

Research output: Contribution to journalArticle

Abstract

Background: The risk of cardiovascular mortality is high among adults with end-stage renal disease (ESRD) undergoing hemodialysis. Waist-to-hip ratio (WHR), a metric of abdominal adiposity, is a predictor of cardiovascular disease (CVD) and mortality in the general population; however, no studies have examined the association with CVD mortality, particularly sudden cardiac death (SCD), in incident hemodialysis. Methods: Among 379 participants incident (< 6 months) to hemodialysis enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in ESRD study, we evaluated associations between WHR and risk of CVD mortality, SCD, and non-CVD mortality in Cox proportional hazards regression models. Results: At study enrollment, mean age was 55 years with 41% females, 73% African Americans, and 57% diabetics. Mean body mass index was 29.3 kg/m2, and mean WHR was 0.95. During a median follow-up time of 2.5 years, there were 35 CVD deaths, 15 SCDs, and 48 non-CVD deaths. Every 0.1 increase in WHR was associated with higher risk (hazard ratio [95% CI]) of CVD mortality (1.75 [1.06-2.86]) and SCD (2.45 [1.20-5.02]), but not non-CVD mortality (0.93 [0.59-1.45]), independently of demographics, body mass index, comorbidities, inflammation, and traditional CVD risk factors. Conclusions: WHR is significantly associated with CVD mortality including SCD, independently of other CVD risk factors in incident hemodialysis. This simple, easily obtained bedside metric may be useful in dialysis patients for CVD risk stratification.

Original languageEnglish (US)
Pages (from-to)406-414
Number of pages9
JournalAmerican Journal of Nephrology
DOIs
StateAccepted/In press - Jan 1 2018

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Adiposity
Renal Dialysis
Cardiovascular Diseases
Waist-Hip Ratio
Mortality
Sudden Cardiac Death
Chronic Kidney Failure
Body Mass Index
Proportional Hazards Models
African Americans
Comorbidity
Dialysis
Heart Diseases
Odds Ratio
Demography
Inflammation

Keywords

  • Abdominal adiposity
  • End stage renal disease
  • Mortality
  • Sudden cardiac death
  • Waist-to-hip ratio

ASJC Scopus subject areas

  • Nephrology

Cite this

Association of Abdominal Adiposity with Cardiovascular Mortality in Incident Hemodialysis. / Fitzpatrick, Jessica; Sozio, Stephen M; Jaar, Bernard; McAdams Demarco, Mara Ann; Estrella, Michelle M.; Tereshchenko, Larisa G.; Monroy-Trujillo, Jose; Parekh, Rulan S.

In: American Journal of Nephrology, 01.01.2018, p. 406-414.

Research output: Contribution to journalArticle

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abstract = "Background: The risk of cardiovascular mortality is high among adults with end-stage renal disease (ESRD) undergoing hemodialysis. Waist-to-hip ratio (WHR), a metric of abdominal adiposity, is a predictor of cardiovascular disease (CVD) and mortality in the general population; however, no studies have examined the association with CVD mortality, particularly sudden cardiac death (SCD), in incident hemodialysis. Methods: Among 379 participants incident (< 6 months) to hemodialysis enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in ESRD study, we evaluated associations between WHR and risk of CVD mortality, SCD, and non-CVD mortality in Cox proportional hazards regression models. Results: At study enrollment, mean age was 55 years with 41{\%} females, 73{\%} African Americans, and 57{\%} diabetics. Mean body mass index was 29.3 kg/m2, and mean WHR was 0.95. During a median follow-up time of 2.5 years, there were 35 CVD deaths, 15 SCDs, and 48 non-CVD deaths. Every 0.1 increase in WHR was associated with higher risk (hazard ratio [95{\%} CI]) of CVD mortality (1.75 [1.06-2.86]) and SCD (2.45 [1.20-5.02]), but not non-CVD mortality (0.93 [0.59-1.45]), independently of demographics, body mass index, comorbidities, inflammation, and traditional CVD risk factors. Conclusions: WHR is significantly associated with CVD mortality including SCD, independently of other CVD risk factors in incident hemodialysis. This simple, easily obtained bedside metric may be useful in dialysis patients for CVD risk stratification.",
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AU - Estrella, Michelle M.

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