title: Survival predictability of lean and fat mass in men and women undergoing maintenance hemodialysis.
abstract: BACKGROUND
  Larger body size is associated with greater survival in maintenance hemodialysis (MHD) patients. It is not clear how lean body mass (LBM) and fat mass (FM) compare in their associations with survival across sex in these patients.
  
  
  OBJECTIVE
  We examined the hypothesis that higher FM and LBM are associated with greater survival in MHD patents irrespective of sex.
  
  
  METHODS
  In 742 MHD patients, including 31% African Americans with a mean (± SD) age of 54 ± 15 y, we categorized men (n = 391) and women (n = 351) separately into 4 quartiles of near-infrared interactance-measured LBM and FM. Cox proportional hazards models estimated death hazard ratios (HRs) (and 95% CIs), and cubic spline models were used to examine associations with mortality over 5 y (2001-2006).
  
  
  RESULTS
  After adjustment for case-mix and inflammatory markers, the highest quartiles of FM and LBM were associated with greater survival in women: HRs of 0.38 (95% CI: 0.20, 0.71) and 0.34 (95% CI: 0.17, 0.67), respectively (reference: first quartile). In men, the highest quartiles of FM and percentage FM (FM%) but not of LBM were associated with greater survival: HRs of 0.51 (95% CI: 0.27, 0.96), 0.45 (95% CI: 0.23, 0.88), and 1.17 (95% CI: 0.60, 2.27), respectively. Cubic spline analyses showed greater survival with higher FM% and higher "FM minus LBM percentiles" in both sexes, whereas a higher LBM was protective in women.
  
  
  CONCLUSIONS
  In MHD patients, higher FM in both sexes and higher LBM in women appear to be protective. The survival advantage of FM appears to be superior to that of LBM. Clinical trials to examine the outcomes of interventions that modify body composition in MHD patients are indicated.
authors.affiliation: Harold Simmons Center for Kidney Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502, USA.
authors.forename: Nazanin
authors.initials: N
authors.lastname: Noori
authors.forename: Csaba P
authors.initials: CP
authors.lastname: Kovesdy
authors.forename: Ramanath
authors.initials: R
authors.lastname: Dukkipati
authors.forename: Youngmee
authors.initials: Y
authors.lastname: Kim
authors.forename: Uyen
authors.initials: U
authors.lastname: Duong
authors.forename: Rachelle
authors.initials: R
authors.lastname: Bross
authors.forename: Antigone
authors.initials: A
authors.lastname: Oreopoulos
authors.forename: Amanda
authors.initials: A
authors.lastname: Luna
authors.forename: Debbie
authors.initials: D
authors.lastname: Benner
authors.forename: Joel D
authors.initials: JD
authors.lastname: Kopple
authors.forename: Kamyar
authors.initials: K
authors.lastname: Kalantar-Zadeh
mesh_terms: D000273:Adipose Tissue; D000328:Adult; D000368:Aged; D001823:Body Composition; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000401:mortality*; D051437:Renal Insufficiency / Q000401:mortality* / Q000628:therapy; D012737:Sex Factors; D016019:Survival Analysis