Survival predictability of lean and fat mass in men and women undergoing maintenance hemodialysis.
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.
Noori
Nazanin
N
Harold Simmons Center for Kidney Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502, USA.
Kovesdy
Csaba P
CP
Dukkipati
Ramanath
R
Kim
Youngmee
Y
Duong
Uyen
U
Bross
Rachelle
R
Oreopoulos
Antigone
A
Luna
Amanda
A
Benner
Debbie
D
Kopple
Joel D
JD
Kalantar-Zadeh
Kamyar
K
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