Time-varying effects of body mass index on mortality among hemodialysis patients: Results from a nationwide korean registry

Sejoong Kim, Jong Cheol Jeong, Shin Young Ahn, Kibbeum Doh, Dong Chan Jin, Ki Young Na

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    11 Citations (Scopus)


    Background: Unlike patterns observed in the general population, obesity is associated with better survival among hemodialysis patients, which could be explained by reverse causation or illness-related weight loss. However, the time-varying effect of body mass index (BMI) on hemodialysis survival has not been investigated. Therefore, this study investigated the time-varying effect of BMI on mortality after starting hemodialysis. Methods: In the present study, we examined Korean Society of Nephrology data from 16,069 adult patients who started hemodialysis during or after the year 2000. Complete survival data were obtained from Statistics Korea. Survival analysis was performed using Cox regression and a non-proportional hazard fractional polynomial model. Results: During the median follow-up of 8.6 years, 9,272 patients (57.7%) died. Compared to individuals with normal BMI (18.5-24.9 kg/m2), the underweight group (< 18.5 kg/m2) had a higer mortality hazard ratio (HR, 1.292; 95% confidence interval [CI], 1.203-1.387; P < 0.001) and the overweight group (25.0-29.9 kg/m2) had a lower mortality HR (0.904; 95% CI, 0.829-0.985; P = 0.022). The underweight group had increasing HRs during the first 3 to 7 years after starting hemodialysis, which varied according to age group. The young obese group (< 40 years old) had a U-shaped temporal trend in their mortality HRs, which reflected increased mortality after 7 years. Conclusion: The obese hemodialysis group had better survival during the early post-dialysis period, although the beneficial effect of obesity disappeared 7 years after starting hemodialysis. The young obese group also had an increased mortality HR after 7 years.

    Original languageEnglish
    Pages (from-to)90-99
    Number of pages10
    JournalKidney Research and Clinical Practice
    Issue number1
    Publication statusPublished - 2019 Mar


    • Body mass index
    • Obesity
    • Renal dialysis
    • Reverse causation
    • Time-varying hazard

    ASJC Scopus subject areas

    • Nephrology
    • Urology


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