Impact of body mass on incidence and prognosis of acute kidney injury requiring renal replacement therapy.
OBJECTIVE
In patients with chronic kidney disease, survival has been shown to be better with increasing body mass, an observation which was termed the "obesity paradox". To investigate if such an effect would also be present in patients with acute kidney injury (AKI), we analysed the impact of body mass on the prognosis of intensive care patients with severe AKI requiring renal replacement therapy.


METHODS
A total of 5,232 patients with AKI requiring renal replacement therapy from 53 Austrian ICUs were analysed.


RESULTS
Patients were divided into one of five BMI groups: underweight, normal, overweight, obese and morbid obese. The incidence of AKI increased with increasing body mass from underweight, normal (5.4%) to morbid obese (11.8%). Moreover, adjusted odds ratios to develop AKI were significantly increased for all groups (reference group: normal). Risk-adjusted hospital mortality rates followed a U-shaped pattern, with the lowest mortality in obese patients (BMI of > or = 30 < 35). Multivariate analysis (with adjustment for severity of illness, sex, reason for admission and comorbidities) confirmed these results: obese patients presented with a significantly reduced probability to die in the hospital [odds ratio 0.81 (0.66-0.98)].


CONCLUSIONS
Obesity is an independent risk factor for developing AKI. Our results provide further evidence that body mass impacts on survival of patients with AKI requiring renal replacement therapy. Obese patients seem to have a survival benefit compared to underweight or normal weight patients.
Druml
Wilfred
W
Division of Nephrology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria. wilfred.druml@meduniwien.ac.at
Metnitz
Barbara
B
Schaden
Eva
E
Bauer
Peter
P
Metnitz
Philipp G H
PG
D018806:APACHE; D058186:Acute Kidney Injury / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy; D001317:Austria / Q000453:epidemiology; D015992:Body Mass Index; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications; D011379:Prognosis; D011446:Prospective Studies; D017582:Renal Replacement Therapy; D018570:Risk Assessment / Q000379:methods; D016019:Survival Analysis