title: Changes in anthropometry and mortality in maintenance hemodialysis patients in the HEMO Study.
abstract: BACKGROUND
  Poor nutritional status has been associated with worse patient survival in maintenance hemodialysis patients. Anthropometric values are important nutritional measures, incorporating muscle and fat mass. However, the association of changes in anthropometry, including midarm circumference (MAC) and skinfold measurements, with mortality in hemodialysis patients remains unknown. Accordingly, we explored this association in the Hemodialysis (HEMO) Study.
  
  
  METHODS
  Post hoc analysis of cohort data from a clinical trial.
  
  
  METHODS
  1,846 hemodialysis patients enrolled in the HEMO Study.
  
  
  METHODS
  MAC and skinfold measurements.
  
  
  RESULTS
  Longitudinal changes in MAC and skinfolds were jointly modeled using repeated measures and survival modeling. Time-to-event outcomes were all-cause mortality, cardiac death and hospitalization, and infection-related death.
  
  
  RESULTS
  Mean MAC was 30.1 cm, and mean baseline sum of subscapular, biceps, and triceps skinfolds was 42.4 mm. During a median follow-up of 2.5 years, there were 845 deaths. During follow-up, MAC and the skinfold measurement declined 0.26 cm and 1.1 mm per year, respectively. Declines in MAC (per cm) and skinfold (per mm) measurements were associated with higher all-cause mortality (HRs of 1.58 [95% CI, 1.29-1.94; P < 0.001] and 1.06 [95% CI, 0.99-1.13; P = 0.09], respectively), poorer cardiac outcomes (HRs of 1.49 [95% CI, 1.23-1.81; P < 0.001] and 1.05 [95% CI, 0.99-1.10; P = 0.09], respectively), and higher infection-related hospitalization (HRs of 2.45 [95% CI, 1.55-3.88; P < 0.001] and 1.16 [95% CI, 0.98-1.37; P = 0.08], respectively). The association between declining MAC and skinfold with patient survival was most notable for those with body mass index (BMI) ≤25 kg/m2 (HRs of 2.41 [95% CI, 1.81-3.19; P < 0.001] and 1.22 [95% CI, 1.10-1.35; P < 0.001], respectively).
  
  
  CONCLUSIONS
  Prevalent dialysis patients only, excluding individuals weighing >85 kg.
  
  
  CONCLUSIONS
  Declines in skinfold thickness were not associated significantly with outcomes except for participants with BMI ≤25 kg/m2. Declines in MAC are associated significantly with all-cause mortality and cardiac outcomes in hemodialysis patients, most notably in those with BMI ≤25 kg/m2.
authors.affiliation: Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA; Division of Nephrology, National Taiwan University Hospital, Yun-Lin branch, Taiwan.
authors.forename: Chi-Ting
authors.initials: CT
authors.lastname: Su
authors.forename: Jonathan
authors.initials: J
authors.lastname: Yabes
authors.forename: Francis
authors.initials: F
authors.lastname: Pike
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Weiner
authors.forename: Srinivasan
authors.initials: S
authors.lastname: Beddhu
authors.forename: Jerrilynn D
authors.initials: JD
authors.lastname: Burrowes
authors.forename: Michael V
authors.initials: MV
authors.lastname: Rocco
authors.forename: Mark L
authors.initials: ML
authors.lastname: Unruh
mesh_terms: D000328:Adult; D000368:Aged; D000886:Anthropometry; D015992:Body Mass Index; D002423:Cause of Death; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D006435:Renal Dialysis / Q000379:methods / Q000401:mortality*; D012885:Skinfold Thickness; D016019:Survival Analysis; D014481:United States
keywords: Anthropometry; body mass index (BMI); hemodialysis; joint model analysis; survival analysis