title: Initial body mass indexes have contrary effects on change in body weight and mortality of patients on maintenance hemodialysis treatment.
abstract: Malnutrition is a relevant risk factor for mortality for patients on maintenance hemodialysis treatment. In a retrospective study including 377 patients who began hemodialysis treatment between 1986 and 2001, we assessed the prevalence of different statuses of nutrition and the impact of the initial status of nutrition on the change in body weight and patient survival. We found an inverse relationship between body mass index (BMI, kg/m2) and the gain in body weight and BMI within 12 months of hemodialysis treatment. Underweight and normal weight patients had a substantial increase in these parameters, greatest in underweight subjects, whereas overweight and obese patients showed only a moderate increase or none (P =.0019, P =.00036). Adjusted mortality rates showed an inverse correlation with the initial BMI (P <.0001). There was a statistically significant difference in the mortality between patients with normal weight and overweight or obesity, respectively, showing a more favorable prognosis in overweight and obese patients (P =.0007; P =.022; log-rank, normal versus overweight, P =.012). Weight loss was the greatest independent risk factor for mortality in general. Adjusted hazard ratio of death was highest in underweight patients (3.999; CI, 2.708 to 5.905; P <.0001) and decreased to 2.251 (CI, 1.795 to 2.822; P <.0001) in normal weight, 1.927 (CI, 1.390 to 2.670; P <.0001) in overweight, and 1.651 (CI, 0.841 to 3.236; P =.1439) in obese subjects when patients with weight loss were compared with patients who preserved their initial weight or gained weight. Overall, the initial BMI has an influence on the change in body weight as well as on patient survival in general and in the case of weight loss in particular.
authors.affiliation: Ludwig Boltzmann Institute of Nephrology and 1st Clinic of Internal Medicine, St. Poelten, Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Wiesholzer
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Harm
authors.forename: Klaus
authors.initials: K
authors.lastname: Schuster
authors.forename: Dinah
authors.initials: D
authors.lastname: Putz
authors.forename: Christian
authors.initials: C
authors.lastname: Neuhauser
authors.forename: Florian
authors.initials: F
authors.lastname: Fiedler
authors.forename: Peter
authors.initials: P
authors.lastname: Balcke
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003928:Diabetic Nephropathies / Q000150:complications / Q000401:mortality; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality* / Q000628:therapy; D008297:Male; D044342:Malnutrition / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D008875:Middle Aged; D009765:Obesity / Q000401:mortality*; D016017:Odds Ratio; D011379:Prognosis; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D015430:Weight Gain / Q000502:physiology; D015431:Weight Loss / Q000502:physiology