Abstract: TH-PO438

Relationship between Body Mass Index, Inflammation, and Mortality in Hemodialysis Patients

Session Information

Category: Nutrition, Inflammation, and Metabolism

  • 1401 Nutrition, Inflammation, Metabolism

Authors

  • Malhotra, Rakesh, UCSD, San Diego, California, United States
  • Ye, Xiaoling, Renal Research Institute, New York, New York, United States
  • Raimann, Jochen G., Renal Research Institute, New York, New York, United States
  • Usvyat, Len A., Fresenius Medical Care North America, Melrose, Massachusetts, United States
  • Ix, Joachim H., UCSD, San Diego, California, United States
  • van der Sande, Frank, Maastricht University Medical Centre , Maastricht, Netherlands
  • Kotanko, Peter, Renal Research Institute, New York, New York, United States
  • Kooman, Jeroen, Maastricht University Medical Centre , Maastricht, Netherlands
Background

High body mass index (BMI) is associated with improved survival in hemodialysis (HD) patients. Mechanisms responsible are unknown. Here, we evaluate whether neutrophil-lymphocyte ratio (NLR) and serum albumin - markers of inflammation - affect the relationship of BMI with mortality in dialysis subjects.

Methods

We evaluated HD patients enrolled in MONDO (MONitoring Dialysis Outcomes) among whom measurements of neutrophil and lymphocyte counts, albumin, body weight and height were available (n=6162). BMI was categorized by quintiles:<21.3 kg/m2, 21.3 to 24.0 kg/m2, >24.0 to 26.7 kg/m2, >26.7 to 30.4 kg/m2 and >30.4 kg/m2. Patients were classified as inflamed if NLR ≥5.0 or albumin ≤3.1 mg/dL. The main outcome was all-cause mortality over 2 years.

Results

The median (IQR) age was 66 (55-76) years, 57% were male, 46% white and median vintage 4-6 months. During 2-year follow-up, there were 2641(42.9%) deaths(864 in inflamed;1777 in non-inflamed). The protective effect of high BMI was observed in inflamed patients(HR (95% CI) Q1:2.48 (2.10-2.94); Q2:1.73 (1.44-2.09); Q3:1.77 (1.44-2.17); Q4:1.44 (1.16-1.80); and Q5:1.46 (1.18-1.81)); however this effect was mitigated in non-inflamed HD patients(HR (95% CI) for Q1:1.27 (1.08-1.49); Q2:1.06 (0.91-1.24); Q3:0.99 (0.85-1.16); Q4:0.93 (0.80-1.09); and Q5:1.0 (ref)). Further analysis showed that these findings were restricted to Europeans but not in Asians and United states subjects (Fig1).

Conclusion

Our results showed that inflammation may impact the relationship between BMI and survival. Further studies are needed to better understand the interaction between inflammation and the BMI in HD patients.

Figure 1. All-cause mortality by BMI and inflammation stratified by Region; adjusted Cox regression analysis