title: Associations of body mass index and weight loss with mortality in transplant-waitlisted maintenance hemodialysis patients.
abstract: A body mass index (BMI) below morbid obesity range is often a requirement for kidney transplant wait-listing, but data linking BMI changes to mortality during the waitlist period are lacking. By linking the 6-year (7/2001-6/2007) national databases of a large dialysis organization and the Scientific Registry of Transplant Recipients, we identified 14 632 waitlisted hemodialysis patients without kidney transplantation. Time-dependent survival models examined the mortality predictability of 13-week-averaged BMI, pretransplant serum creatinine as a muscle mass surrogate and their changes over time. The patients were on average 52 ± 13 years old, 40% women and had a BMI of 26.9 ± 6.3 kg/m². Each kg/m² increase of BMI was associated with a death hazard ratio (HR) of 0.96 (95%CI: 0.95-0.97). Compared to the lowest creatinine quintile, the 4th and 5th quintiles had death HRs of 0.75 (0.66-0.86) and 0.57 (0.49-0.66), respectively. Compared to minimal (< ± 1 kg) weight change over 6 months, those with 3 kg- < 5 kg and ≥ 5 kg weight loss had death HRs of 1.31 (1.14-1.52) and 1.51 (1.30-1.75), respectively. Similar associations were observed with creatinine changes over time. Transplant-waitlisted hemodialysis patients with lower BMI or muscle mass and/or unintentional weight or muscle loss have higher mortality in this observational study. Impact of intentional weight change remains unclear.
authors: Harold Simmons Center for Chronic Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA.
authors: M Z
authors: MZ
authors: Molnar
authors: E
authors: E
authors: Streja
authors: C P
authors: CP
authors: Kovesdy
authors: S
authors: S
authors: Bunnapradist
authors: M S
authors: MS
authors: Sampaio
authors: J
authors: J
authors: Jing
authors: M
authors: M
authors: Krishnan
authors: A R
authors: AR
authors: Nissenson
authors: G M
authors: GM
authors: Danovitch
authors: K
authors: K
authors: Kalantar-Zadeh
mesh_terms: D015992:Body Mass Index; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality*; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009765:Obesity; D006435:Renal Dialysis / Q000401:mortality*; D015996:Survival Rate; D014850:Waiting Lists; D015431:Weight Loss
chemical_list: D003404:Creatinine