title: Association of body weight changes with mortality in incident hemodialysis patients.
abstract: BACKGROUND
  Incident hemodialysis patients may experience rapid weight loss in the first few months of starting dialysis. However, trends in weight changes over time and their associations with survival have not yet been characterized in this population.
  
  
  METHODS
  In a large contemporary US cohort of 58 106 patients who initiated hemodialysis during 1 January 2007-31 December 2011 and survived the first year of dialysis, we observed trends in weight changes during the first year of treatment and then examined the association of post-dialysis weight changes with all-cause mortality.
  
  
  RESULTS
  Patients' post-dialysis weights rapidly decreased and reached a nadir at the 5th month of dialysis with an average decline of 2% from baseline, whereas obese patients (body mass index ≥30 kg/m 2 ) did not reach a nadir and lost ∼3.8% of their weight by the 12th month. Compared with the reference group (-2 to 2% changes in weight), the death hazard ratios (HRs) of patients with -6 to -2% and greater than or equal to -6% weight loss during the first 5 months were 1.08 (95% confidence interval, 1.02-1.14) and 1.14 (1.07-1.22), respectively. Moreover, the death HRs with 2-6% and ≥6% weight gain during the 5th to 12th months were 0.91 (0.85-0.97) and 0.92 (0.86-0.99), respectively.
  
  
  CONCLUSIONS
  In patients who survive the first year of hemodialysis, a decline in post-dialysis weight is observed and reaches a nadir at the 5th month. An incrementally larger weight loss during the first 12 months is associated with higher death risk, whereas weight gain is associated with greater survival during the 5th to 12th month but not in the first 5 months of dialysis therapy.
authors: Division of Nephrology & Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA.|Department of Internal Medicine, NHIS Medical Center, Ilsan Hospital, Goyangshi, Gyeonggi-do, Republic of Korea.
authors: Tae Ik
authors: TI
authors: Chang
authors: Division of Nephrology & Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA.
authors: Vyvian
authors: V
authors: Ngo
authors: Division of Nephrology & Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA.|Department of Medicine, Long Beach Veteran Affairs Health System, Long Beach, CA, USA.
authors: Elani
authors: E
authors: Streja
authors: Division of Nephrology & Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA.
authors: Jason A
authors: JA
authors: Chou
authors: Division of Nephrology & Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA.
authors: Amanda R
authors: AR
authors: Tortorici
authors: Division of Nephrology & Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA.|Department of Internal Medicine, Inje University, Busan, Republic of Korea.
authors: Tae Hee
authors: TH
authors: Kim
authors: Division of Nephrology & Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA.|Department of Internal Medicine, Soon Chun Hyang University Hospital, Gumi, Republic of Korea.
authors: Tae Woo
authors: TW
authors: Kim
authors: Division of Nephrology & Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA.
authors: Melissa
authors: M
authors: Soohoo
authors: Division of Nephrology & Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA.
authors: Daniel
authors: D
authors: Gillen
authors: Division of Nephrology & Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA.
authors: Connie M
authors: CM
authors: Rhee
authors: Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA.|Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, TN, USA.
authors: Csaba P
authors: CP
authors: Kovesdy
authors: Division of Nephrology & Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA.|Department of Medicine, Long Beach Veteran Affairs Health System, Long Beach, CA, USA.
authors: Kamyar
authors: K
authors: Kalantar-Zadeh
mesh_terms: D015992:Body Mass Index; D001835:Body Weight; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000503:physiopathology*; D006435:Renal Dialysis / Q000401:mortality*; D015996:Survival Rate; D015430:Weight Gain; D015431:Weight Loss
keywords: body mass index; body weight; hemodialysis; mortality