title: Body mass index and causes of death in chronic kidney disease.
abstract: In chronic kidney disease (CKD), a higher body mass index (BMI) is associated with a lower risk for death, but cause-specific death details are unknown across the BMI range. To define this, we studied 54,506 patients with CKD (stage 3 CKD- [91.5%]) from an institutional electronic medical record based-registry. We examined the associations among various causes of death (cardiovascular-, malignancy- and noncardiovascular/nonmalignancy-related deaths) across the BMI range using Cox proportional hazards and competing risks regression models. During a median follow-up of 3.7 years, 14,518 patients died. In the multivariable model, an inverted J-shaped association was noted between BMI and cardiovascular-related, malignancy-related, and noncardiovascular/nonmalignancy-related deaths. Similar associations were noted for BMI 25-29.9, 30-34.9, and 35-39.9 kg/m(2) categories. A BMI >40 kg/m(2) was not associated with cardiovascular-related and noncardiovascular/nonmalignancy-related deaths in CKD. Sensitivity analyses yielded similar results even after adjusting for proteinuria and excluding diabetes and hypertension from the models. In CKD, compared with a BMI of 18.5-24.9 kg/m(2), those who are overweight, with class 1 and 2 obesity have a lower risk for cardiovascular-related, malignancy-related, and noncardiovascular/nonmalignancy-related deaths. Future studies should examine the associations of other measures of adiposity with outcomes in CKD.
authors.affiliation: Section of Nephrology, Department of Medicine, Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, Texas, USA; Section of Nephrology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA. Electronic address: sankar.navaneethan@bcm.edu.
authors.forename: Sankar D
authors.initials: SD
authors.lastname: Navaneethan
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Schold
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Susana
authors.initials: S
authors.lastname: Arrigain
authors.affiliation: Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Kirwan
authors.affiliation: Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Joseph V
authors.initials: JV
authors.lastname: Nally
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002423:Cause of Death; D016009:Chi-Square Distribution; D015897:Comorbidity; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000175:diagnosis / Q000401:mortality*; D009820:Ohio / Q000453:epidemiology; D016016:Proportional Hazards Models; D065840:Protective Factors; D012042:Registries; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000401:mortality*; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors
keywords: cardiovascular deaths and mortality; kidney disease; obesity