Paradoxical Association Between Body Mass Index and Mortality in Men With CKD Not Yet on Dialysis

Csaba P. Kovesdy, John E. Anderson, Kamyar Kalantar-Zadeh

Research output: Contribution to journalArticle

Abstract

Background: Low body mass index (BMI) is associated with greater mortality in patients on dialysis therapy. This relationship is less well characterized in patients with chronic kidney disease (CKD) who are not yet on dialysis therapy. Study Design: Historic prospective cohort. Setting & Participants: 521 male US veterans with CKD (age, 68.8 ± 10.4 years; 21.3% black; estimated glomerular filtration rate, 37.5 ± 16.8 mL/min/1.73 m2 [0.62 ± 0.28 mL/s/1.73 m2]) at a single medical center. Predictor: BMI. Outcomes & Measurements: Associations with all-cause mortality were explored in fixed-covariate and time-dependent Cox models and sequentially adjusted for demographic characteristics (age and race), case-mix (comorbidity index, smoking, blood pressure, estimated glomerular filtration rate, and medication use), and surrogates of malnutrition and inflammation (serum albumin, cholesterol, and bicarbonate levels; white blood cell count; percentage of lymphocytes; and hemoglobin level). Results: Patients were followed up for up to 5.5 years, and the mortality rate was 128.3 deaths/1,000 patient-years (95% confidence interval [CI], 110.5 to 149.0). Higher BMI was associated with lower mortality in the fixed-covariate Cox models, including the fully adjusted model (adjusted hazard ratios for mortality in the group with BMI in 10th to 50th, 50th to 90th, and >90th versus trend = 0.005). Associations were similar in a time-dependent Cox model (Ptrend = 0.008 in the fully adjusted model). Limitations: Results may not be generalizable. Conclusions: Lower BMI is associated with greater mortality in patients with CKD not yet on dialysis therapy. Adjustment for case-mix and surrogate markers of malnutrition and inflammation attenuated, but did not reverse, this relationship.

Original languageEnglish (US)
Pages (from-to)581-591
Number of pages11
JournalAmerican Journal of Kidney Diseases
Volume49
Issue number5
DOIs
StatePublished - May 2007

Fingerprint

Chronic Renal Insufficiency
Dialysis
Body Mass Index
Proportional Hazards Models
Mortality
Glomerular Filtration Rate
Malnutrition
Inflammation
Risk Adjustment
Diagnosis-Related Groups
Veterans
Bicarbonates
Leukocyte Count
Serum Albumin
Comorbidity
Hemoglobins
Therapeutics
Biomarkers
Smoking
Cholesterol

Keywords

  • body mass index
  • Chronic kidney disease
  • mortality

ASJC Scopus subject areas

  • Nephrology

Cite this

Paradoxical Association Between Body Mass Index and Mortality in Men With CKD Not Yet on Dialysis. / Kovesdy, Csaba P.; Anderson, John E.; Kalantar-Zadeh, Kamyar.

In: American Journal of Kidney Diseases, Vol. 49, No. 5, 05.2007, p. 581-591.

Research output: Contribution to journalArticle

Kovesdy, Csaba P. ; Anderson, John E. ; Kalantar-Zadeh, Kamyar. / Paradoxical Association Between Body Mass Index and Mortality in Men With CKD Not Yet on Dialysis. In: American Journal of Kidney Diseases. 2007 ; Vol. 49, No. 5. pp. 581-591.
@article{749375c59584438ab57e48f9575b19ba,
title = "Paradoxical Association Between Body Mass Index and Mortality in Men With CKD Not Yet on Dialysis",
abstract = "Background: Low body mass index (BMI) is associated with greater mortality in patients on dialysis therapy. This relationship is less well characterized in patients with chronic kidney disease (CKD) who are not yet on dialysis therapy. Study Design: Historic prospective cohort. Setting & Participants: 521 male US veterans with CKD (age, 68.8 ± 10.4 years; 21.3{\%} black; estimated glomerular filtration rate, 37.5 ± 16.8 mL/min/1.73 m2 [0.62 ± 0.28 mL/s/1.73 m2]) at a single medical center. Predictor: BMI. Outcomes & Measurements: Associations with all-cause mortality were explored in fixed-covariate and time-dependent Cox models and sequentially adjusted for demographic characteristics (age and race), case-mix (comorbidity index, smoking, blood pressure, estimated glomerular filtration rate, and medication use), and surrogates of malnutrition and inflammation (serum albumin, cholesterol, and bicarbonate levels; white blood cell count; percentage of lymphocytes; and hemoglobin level). Results: Patients were followed up for up to 5.5 years, and the mortality rate was 128.3 deaths/1,000 patient-years (95{\%} confidence interval [CI], 110.5 to 149.0). Higher BMI was associated with lower mortality in the fixed-covariate Cox models, including the fully adjusted model (adjusted hazard ratios for mortality in the group with BMI in 10th to 50th, 50th to 90th, and >90th versus trend = 0.005). Associations were similar in a time-dependent Cox model (Ptrend = 0.008 in the fully adjusted model). Limitations: Results may not be generalizable. Conclusions: Lower BMI is associated with greater mortality in patients with CKD not yet on dialysis therapy. Adjustment for case-mix and surrogate markers of malnutrition and inflammation attenuated, but did not reverse, this relationship.",
keywords = "body mass index, Chronic kidney disease, mortality",
author = "Kovesdy, {Csaba P.} and Anderson, {John E.} and Kamyar Kalantar-Zadeh",
year = "2007",
month = "5",
doi = "10.1053/j.ajkd.2007.02.277",
language = "English (US)",
volume = "49",
pages = "581--591",
journal = "American Journal of Kidney Diseases",
issn = "0272-6386",
publisher = "W.B. Saunders Ltd",
number = "5",

}

TY - JOUR

T1 - Paradoxical Association Between Body Mass Index and Mortality in Men With CKD Not Yet on Dialysis

AU - Kovesdy, Csaba P.

AU - Anderson, John E.

AU - Kalantar-Zadeh, Kamyar

PY - 2007/5

Y1 - 2007/5

N2 - Background: Low body mass index (BMI) is associated with greater mortality in patients on dialysis therapy. This relationship is less well characterized in patients with chronic kidney disease (CKD) who are not yet on dialysis therapy. Study Design: Historic prospective cohort. Setting & Participants: 521 male US veterans with CKD (age, 68.8 ± 10.4 years; 21.3% black; estimated glomerular filtration rate, 37.5 ± 16.8 mL/min/1.73 m2 [0.62 ± 0.28 mL/s/1.73 m2]) at a single medical center. Predictor: BMI. Outcomes & Measurements: Associations with all-cause mortality were explored in fixed-covariate and time-dependent Cox models and sequentially adjusted for demographic characteristics (age and race), case-mix (comorbidity index, smoking, blood pressure, estimated glomerular filtration rate, and medication use), and surrogates of malnutrition and inflammation (serum albumin, cholesterol, and bicarbonate levels; white blood cell count; percentage of lymphocytes; and hemoglobin level). Results: Patients were followed up for up to 5.5 years, and the mortality rate was 128.3 deaths/1,000 patient-years (95% confidence interval [CI], 110.5 to 149.0). Higher BMI was associated with lower mortality in the fixed-covariate Cox models, including the fully adjusted model (adjusted hazard ratios for mortality in the group with BMI in 10th to 50th, 50th to 90th, and >90th versus trend = 0.005). Associations were similar in a time-dependent Cox model (Ptrend = 0.008 in the fully adjusted model). Limitations: Results may not be generalizable. Conclusions: Lower BMI is associated with greater mortality in patients with CKD not yet on dialysis therapy. Adjustment for case-mix and surrogate markers of malnutrition and inflammation attenuated, but did not reverse, this relationship.

AB - Background: Low body mass index (BMI) is associated with greater mortality in patients on dialysis therapy. This relationship is less well characterized in patients with chronic kidney disease (CKD) who are not yet on dialysis therapy. Study Design: Historic prospective cohort. Setting & Participants: 521 male US veterans with CKD (age, 68.8 ± 10.4 years; 21.3% black; estimated glomerular filtration rate, 37.5 ± 16.8 mL/min/1.73 m2 [0.62 ± 0.28 mL/s/1.73 m2]) at a single medical center. Predictor: BMI. Outcomes & Measurements: Associations with all-cause mortality were explored in fixed-covariate and time-dependent Cox models and sequentially adjusted for demographic characteristics (age and race), case-mix (comorbidity index, smoking, blood pressure, estimated glomerular filtration rate, and medication use), and surrogates of malnutrition and inflammation (serum albumin, cholesterol, and bicarbonate levels; white blood cell count; percentage of lymphocytes; and hemoglobin level). Results: Patients were followed up for up to 5.5 years, and the mortality rate was 128.3 deaths/1,000 patient-years (95% confidence interval [CI], 110.5 to 149.0). Higher BMI was associated with lower mortality in the fixed-covariate Cox models, including the fully adjusted model (adjusted hazard ratios for mortality in the group with BMI in 10th to 50th, 50th to 90th, and >90th versus trend = 0.005). Associations were similar in a time-dependent Cox model (Ptrend = 0.008 in the fully adjusted model). Limitations: Results may not be generalizable. Conclusions: Lower BMI is associated with greater mortality in patients with CKD not yet on dialysis therapy. Adjustment for case-mix and surrogate markers of malnutrition and inflammation attenuated, but did not reverse, this relationship.

KW - body mass index

KW - Chronic kidney disease

KW - mortality

UR - http://www.scopus.com/inward/record.url?scp=34247476791&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34247476791&partnerID=8YFLogxK

U2 - 10.1053/j.ajkd.2007.02.277

DO - 10.1053/j.ajkd.2007.02.277

M3 - Article

C2 - 17472839

AN - SCOPUS:34247476791

VL - 49

SP - 581

EP - 591

JO - American Journal of Kidney Diseases

JF - American Journal of Kidney Diseases

SN - 0272-6386

IS - 5

ER -