TY - JOUR
T1 - Body Mass Index and Mortality in CKD
AU - Madero, Magdalena
AU - Sarnak, Mark J.
AU - Wang, Xuelei
AU - Sceppa, Carmen Castaneda
AU - Greene, Tom
AU - Beck, Gerald J.
AU - Kusek, John W.
AU - Collins, Allan J
AU - Levey, Andrew S.
AU - Menon, Vandana
N1 - Funding Information:
Support: This study was funded by National Institutes of Diabetes and Digestive and Kidney Diseases grants K23 DK067303, K23 DK02904; and UO1 DK 35073.
PY - 2007/9
Y1 - 2007/9
N2 - Background: Greater body mass index (BMI) is associated with worse survival in the general population, but appears to confer a survival advantage in patients with kidney failure treated by hemodialysis. Data are limited on the relationship of BMI with mortality in patients in the earlier stages of chronic kidney disease (CKD). Study Design: Cohort study. Setting & Participants: The Modification of Diet in Renal Disease (MDRD) Study examined the effects of dietary protein restriction and blood pressure control on progression of kidney disease. This analysis includes 1,759 subjects. Predictor: BMI. Outcomes & Measurements: Cox models were used to evaluate the relationship of quartiles of BMI with all-cause and cardiovascular disease (CVD) mortality. Results: Mean GFR and BMI were 39 ± 21 (SD) mL/min/1.73 m2 and 27.1 ± 4.7 kg/m2, respectively. During a mean follow-up of 10 years, there were 453 deaths (26%), including 272 deaths (16%) from CVD. In unadjusted Cox models, quartiles 3 (hazard ratio [HR], 1.45; 95% confidence interval [CI], 1.11 to 1.90) and 4 (HR, 1.58; 95% CI, 1.21 to 2.06) were associated with increased risk of all-cause mortality compared with quartile 1. Adjustment for demographic, CVD, and kidney disease risk factors and randomization status attenuated this relationship for quartiles 3 (HR, 0.81; 95% CI, 0.60 to 1.09) and 4 (HR, 0.83; 95% CI, 0.61 to 1.20). In unadjusted Cox models, quartiles 3 (HR, 1.66; 95% CI, 1.17 to 2.36) and 4 (HR, 1.63; 95% CI, 1.15 to 2.33) were associated with increased risk of CVD mortality. Multivariable adjustment attenuated this relationship for quartiles 3 (HR, 0.92; 95% CI, 0.63 to 1.36) and 4 (HR, 0.85; 95% CI, 0.57 to 1.27). Limitations: Primary analyses were based on single measurement of BMI. Because the MDRD Study cohort included relatively young white subjects with predominantly nondiabetic CKD, results may not be generalizable to all patients with CKD. Conclusions: In this cohort of subjects with predominantly nondiabetic CKD, BMI does not appear to be an independent predictor of all-cause or CVD mortality.
AB - Background: Greater body mass index (BMI) is associated with worse survival in the general population, but appears to confer a survival advantage in patients with kidney failure treated by hemodialysis. Data are limited on the relationship of BMI with mortality in patients in the earlier stages of chronic kidney disease (CKD). Study Design: Cohort study. Setting & Participants: The Modification of Diet in Renal Disease (MDRD) Study examined the effects of dietary protein restriction and blood pressure control on progression of kidney disease. This analysis includes 1,759 subjects. Predictor: BMI. Outcomes & Measurements: Cox models were used to evaluate the relationship of quartiles of BMI with all-cause and cardiovascular disease (CVD) mortality. Results: Mean GFR and BMI were 39 ± 21 (SD) mL/min/1.73 m2 and 27.1 ± 4.7 kg/m2, respectively. During a mean follow-up of 10 years, there were 453 deaths (26%), including 272 deaths (16%) from CVD. In unadjusted Cox models, quartiles 3 (hazard ratio [HR], 1.45; 95% confidence interval [CI], 1.11 to 1.90) and 4 (HR, 1.58; 95% CI, 1.21 to 2.06) were associated with increased risk of all-cause mortality compared with quartile 1. Adjustment for demographic, CVD, and kidney disease risk factors and randomization status attenuated this relationship for quartiles 3 (HR, 0.81; 95% CI, 0.60 to 1.09) and 4 (HR, 0.83; 95% CI, 0.61 to 1.20). In unadjusted Cox models, quartiles 3 (HR, 1.66; 95% CI, 1.17 to 2.36) and 4 (HR, 1.63; 95% CI, 1.15 to 2.33) were associated with increased risk of CVD mortality. Multivariable adjustment attenuated this relationship for quartiles 3 (HR, 0.92; 95% CI, 0.63 to 1.36) and 4 (HR, 0.85; 95% CI, 0.57 to 1.27). Limitations: Primary analyses were based on single measurement of BMI. Because the MDRD Study cohort included relatively young white subjects with predominantly nondiabetic CKD, results may not be generalizable to all patients with CKD. Conclusions: In this cohort of subjects with predominantly nondiabetic CKD, BMI does not appear to be an independent predictor of all-cause or CVD mortality.
KW - Kidney disease
KW - cardiovascular mortality
KW - outcomes
UR - https://www.scopus.com/pages/publications/34548007923
UR - https://www.scopus.com/pages/publications/34548007923#tab=citedBy
U2 - 10.1053/j.ajkd.2007.06.004
DO - 10.1053/j.ajkd.2007.06.004
M3 - Article
C2 - 17720519
AN - SCOPUS:34548007923
SN - 0272-6386
VL - 50
SP - 404
EP - 411
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 3
ER -
