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Association of body weight changes with mortality in incident hemodialysis patients.
Nephrol Dial Transplant. 2017 Sep 01; 32(9):1549-1558.ND

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+Show Affiliations

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.Division of Nephrology & Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA.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.Division of Nephrology & Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA.Division of Nephrology & Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA.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.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.Division of Nephrology & Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA.Division of Nephrology & Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA.Division of Nephrology & Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA.Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA. Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, TN, USA.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.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27789782

Citation

Chang, Tae Ik, et al. "Association of Body Weight Changes With Mortality in Incident Hemodialysis Patients." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 32, no. 9, 2017, pp. 1549-1558.
Chang TI, Ngo V, Streja E, et al. Association of body weight changes with mortality in incident hemodialysis patients. Nephrol Dial Transplant. 2017;32(9):1549-1558.
Chang, T. I., Ngo, V., Streja, E., Chou, J. A., Tortorici, A. R., Kim, T. H., Kim, T. W., Soohoo, M., Gillen, D., Rhee, C. M., Kovesdy, C. P., & Kalantar-Zadeh, K. (2017). Association of body weight changes with mortality in incident hemodialysis patients. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 32(9), 1549-1558. https://doi.org/10.1093/ndt/gfw373
Chang TI, et al. Association of Body Weight Changes With Mortality in Incident Hemodialysis Patients. Nephrol Dial Transplant. 2017 Sep 1;32(9):1549-1558. PubMed PMID: 27789782.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of body weight changes with mortality in incident hemodialysis patients. AU - Chang,Tae Ik, AU - Ngo,Vyvian, AU - Streja,Elani, AU - Chou,Jason A, AU - Tortorici,Amanda R, AU - Kim,Tae Hee, AU - Kim,Tae Woo, AU - Soohoo,Melissa, AU - Gillen,Daniel, AU - Rhee,Connie M, AU - Kovesdy,Csaba P, AU - Kalantar-Zadeh,Kamyar, PY - 2016/04/20/received PY - 2016/09/17/accepted PY - 2016/11/1/pubmed PY - 2018/6/1/medline PY - 2016/11/1/entrez KW - body mass index KW - body weight KW - hemodialysis KW - mortality SP - 1549 EP - 1558 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol. Dial. Transplant. VL - 32 IS - 9 N2 - 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. SN - 1460-2385 UR - https://www.unboundmedicine.com/medline/citation/27789782/Association_of_body_weight_changes_with_mortality_in_incident_hemodialysis_patients_ L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfw373 DB - PRIME DP - Unbound Medicine ER -