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Body mass index, dialysis modality, and survival: analysis of the United States Renal Data System Dialysis Morbidity and Mortality Wave II Study.
Kidney Int. 2004 Feb; 65(2):597-605.KI

Abstract

BACKGROUND

The impact of obesity on survival in end-stage renal disease (ESRD) patients as related to dialysis modality (i.e., a direct comparison of hemodialysis with peritoneal dialysis) has not been assessed adjusting for differences in medication use, follow-up > or =2 years, or accounting for changes in dialysis modality.

METHODS

We performed a retrospective cohort study of the United States Renal Data System (USRDS) Dialysis Morbidity and Mortality Wave II Study (DMMS) patients who started dialysis in 1996, and were followed until October 31 2001. Cox regression analysis was used to model adjusted hazard ratios (AHR) for mortality for categories of body mass index (BMI), both as quartiles and as > or =30 kg/m2 vs. lower. Because such a large proportion of peritoneal dialysis patients changed to hemodialysis during the study period (45.5%), a sensitivity analysis was performed calculating survival time both censoring and not censoring on the date of change from peritoneal dialysis to hemodialysis.

RESULTS

There were 1675 hemodialysis and 1662 peritoneal dialysis patients. Among hemodialysis patients, 5-year survival for patients with BMI > or =30 kg/m2 was 39.8% vs. 32.3% for lower BMI (P < 0.01 by log-rank test). Among peritoneal dialysis patients, 5-year survival for patients with BMI >/=30 kg/m2 was 38.7% vs. 40.4% for lower BMI (P > 0.05 by log-rank test). In adjusted analysis, BMI > or = 30 kg/m2 was associated with improved survival in hemodialysis patients (AHR 0.89; 95% CI 0.81, 0.99; P= 0.042) but not peritoneal dialysis patients (AHR = 0.99; 95% CI, 0.86, 1.15; P= 0.89). Results were not different on censoring of change from peritoneal dialysis to hemodialysis.

CONCLUSION

We conclude that any survival advantage associated with obesity among chronic dialysis patients is significantly less likely for peritoneal dialysis patients, compared to hemodialysis patients.

Authors+Show Affiliations

Nephrology Service, Walter Reed Army Medical Center, Washington, DC 20037, USA. kevin.abbott@na.amedd.army.milNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

14717930

Citation

Abbott, Kevin C., et al. "Body Mass Index, Dialysis Modality, and Survival: Analysis of the United States Renal Data System Dialysis Morbidity and Mortality Wave II Study." Kidney International, vol. 65, no. 2, 2004, pp. 597-605.
Abbott KC, Glanton CW, Trespalacios FC, et al. Body mass index, dialysis modality, and survival: analysis of the United States Renal Data System Dialysis Morbidity and Mortality Wave II Study. Kidney Int. 2004;65(2):597-605.
Abbott, K. C., Glanton, C. W., Trespalacios, F. C., Oliver, D. K., Ortiz, M. I., Agodoa, L. Y., Cruess, D. F., & Kimmel, P. L. (2004). Body mass index, dialysis modality, and survival: analysis of the United States Renal Data System Dialysis Morbidity and Mortality Wave II Study. Kidney International, 65(2), 597-605.
Abbott KC, et al. Body Mass Index, Dialysis Modality, and Survival: Analysis of the United States Renal Data System Dialysis Morbidity and Mortality Wave II Study. Kidney Int. 2004;65(2):597-605. PubMed PMID: 14717930.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Body mass index, dialysis modality, and survival: analysis of the United States Renal Data System Dialysis Morbidity and Mortality Wave II Study. AU - Abbott,Kevin C, AU - Glanton,Christopher W, AU - Trespalacios,Fernando C, AU - Oliver,David K, AU - Ortiz,Maria I, AU - Agodoa,Lawrence Y, AU - Cruess,David F, AU - Kimmel,Paul L, PY - 2004/1/14/pubmed PY - 2004/9/15/medline PY - 2004/1/14/entrez SP - 597 EP - 605 JF - Kidney international JO - Kidney Int VL - 65 IS - 2 N2 - BACKGROUND: The impact of obesity on survival in end-stage renal disease (ESRD) patients as related to dialysis modality (i.e., a direct comparison of hemodialysis with peritoneal dialysis) has not been assessed adjusting for differences in medication use, follow-up > or =2 years, or accounting for changes in dialysis modality. METHODS: We performed a retrospective cohort study of the United States Renal Data System (USRDS) Dialysis Morbidity and Mortality Wave II Study (DMMS) patients who started dialysis in 1996, and were followed until October 31 2001. Cox regression analysis was used to model adjusted hazard ratios (AHR) for mortality for categories of body mass index (BMI), both as quartiles and as > or =30 kg/m2 vs. lower. Because such a large proportion of peritoneal dialysis patients changed to hemodialysis during the study period (45.5%), a sensitivity analysis was performed calculating survival time both censoring and not censoring on the date of change from peritoneal dialysis to hemodialysis. RESULTS: There were 1675 hemodialysis and 1662 peritoneal dialysis patients. Among hemodialysis patients, 5-year survival for patients with BMI > or =30 kg/m2 was 39.8% vs. 32.3% for lower BMI (P < 0.01 by log-rank test). Among peritoneal dialysis patients, 5-year survival for patients with BMI >/=30 kg/m2 was 38.7% vs. 40.4% for lower BMI (P > 0.05 by log-rank test). In adjusted analysis, BMI > or = 30 kg/m2 was associated with improved survival in hemodialysis patients (AHR 0.89; 95% CI 0.81, 0.99; P= 0.042) but not peritoneal dialysis patients (AHR = 0.99; 95% CI, 0.86, 1.15; P= 0.89). Results were not different on censoring of change from peritoneal dialysis to hemodialysis. CONCLUSION: We conclude that any survival advantage associated with obesity among chronic dialysis patients is significantly less likely for peritoneal dialysis patients, compared to hemodialysis patients. SN - 0085-2538 UR - https://www.unboundmedicine.com/medline/citation/14717930/Body_mass_index_dialysis_modality_and_survival:_analysis_of_the_United_States_Renal_Data_System_Dialysis_Morbidity_and_Mortality_Wave_II_Study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0085-2538(15)49742-X DB - PRIME DP - Unbound Medicine ER -