title: Inflammation and inverse associations of body mass index and serum creatinine with mortality in hemodialysis patients.
abstract: OBJECTIVE
  Protein-energy wasting and inflammation are common and associated with an increased risk of mortality in hemodialysis (HD) patients. We examined the extent to which they mediate the associations of each other with death in this population.
  
  
  METHODS
  Retrospective analysis of the Hemodialysis (HEMO) Study data.
  
  
  METHODS
  Prevalent HD patients.
  
  
  METHODS
  One-thousand HEMO study participants with data available on C-reactive protein (CRP), body mass index (BMI), and serum creatinine.
  
  
  METHODS
  None.
  
  
  METHODS
  The associations of CRP, BMI, and serum creatinine with time to all-cause mortality separately and together in multivariate Cox models.
  
  
  RESULTS
  In 1,437 patient-years of follow-up, there were 265 (26.5%) all-cause deaths. Compared with the lowest CRP quartile, the highest quartile was associated with a hazard ratio (HR) of 2.02 (95% confidence interval [CI], 1.31-3.10) for all-cause mortality. This association of highest CRP quartile with mortality was not attenuated with further adjustment for BMI and serum creatinine (HR, 2.13; 95% CI, 1.38-3.30). When serum albumin was added to the model, the hazard of death associated with highest CRP quartile was modestly attenuated (HR, 1.88; 95% CI, 1.21-2.92). In contrast, both BMI (for each kg/m2 increase; HR, 0.94; 95% CI, 0.91-0.96 for all-cause mortality) and serum creatinine (for each mg/dL increase; HR, 0.85; 95% CI, 0.79-0.90 for all-cause mortality) had strong, independent protective effects. Further adjustment with CRP had a negligible effect on these associations.
  
  
  CONCLUSIONS
  The associations of markers of nutrition and inflammation with mortality are largely independent of each other in HD patients.
authors.affiliation: Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah 84112, USA. Srinivasan.beddhu@hsc.utah.edu
authors.forename: Srinivasan
authors.initials: S
authors.lastname: Beddhu
authors.forename: Alfred K
authors.initials: AK
authors.lastname: Cheung
authors.forename: Brett
authors.initials: B
authors.lastname: Larive
authors.forename: Tom
authors.initials: T
authors.lastname: Greene
authors.forename: George A
authors.initials: GA
authors.lastname: Kaysen
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Levey
authors.forename: Michael
authors.initials: M
authors.lastname: Rocco
authors.forename: Mark
authors.initials: M
authors.lastname: Sarnak
authors.forename: Robert
authors.initials: R
authors.lastname: Toto
authors.forename: Garabed
authors.initials: G
authors.lastname: Eknoyan
mesh_terms: D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism*; D002423:Cause of Death; D016001:Confidence Intervals; D003404:Creatinine / Q000097:blood*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000150:complications / Q000401:mortality; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D016016:Proportional Hazards Models; D011502:Protein-Energy Malnutrition / Q000150:complications / Q000401:mortality; D006435:Renal Dialysis; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein; D003404:Creatinine