Toida T, Sato Y, Ogata S, Wada A, Masakane I, Fujimoto S. Synergic Impact of Body Mass Index, Diabetes, and Age on Long-Term Mortality in Japanese Incident Hemodialysis Patients: A Cohort Study on a Large National Dialysis Registry.
J Ren Nutr 2019;
30:333-340. [PMID:
31812321 DOI:
10.1053/j.jrn.2019.09.007]
[Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/14/2019] [Accepted: 09/14/2019] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES
The relationships among body mass index (BMI), diabetes, age, and all-cause mortality in hemodialysis patients remain unclear. We examined BMI-stratified relationships between diabetes, age, and the risk of long-term mortality in incident hemodialysis patients.
METHODS
This is a cohort study. Data were obtained from the national dialysis registry in Japan 2007 that included 35,415 incident hemodialysis patients and 6,061 patients aged ≥20 years with BMI data. Patients were divided into 6 categories according to baseline BMI (low: <18.5, normal: 18.5-25, Obesity: ≥25) and the presence or absence of diabetes. The primary outcome was all-cause mortality during a 5-year follow-up. Hazard ratios were estimated using Cox's model for the relationships among diabetes, BMI categories, and all-cause mortality, and adjusted for potential confounders. Patients with a normal BMI and non-diabetic were the reference category. We also examined the effects of age on these relationships.
RESULTS
A total of 6,061 patients, including 3,239 with diabetes, were enrolled. During the follow-up, 31.0% and 30.7% of all and diabetic patients, respectively, died. Cox's regression analysis showed that low BMI, but not obesity, was independently associated with an increased risk of all-cause death in patients with and without diabetes. When patients were divided into 2 groups-younger and older than 60 years-the risk of mortality in both groups was increased in low BMI with diabetes.
CONCLUSIONS
Among Japanese incident hemodialysis patients, low BMI increases the risk of all-cause mortality. The markedly high mortality rate in diabetic patients with low BMI regardless of age warrants attention.
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