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Abstract: FR-PO818

Synergic Impact of BMI, Diabetes, and Age on Long-Term Mortality in Incident Japanese Hemodialysis Patients: A Cohort Study of the Large National Dialysis Registry

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Toida, Tatsunori, University of Miyazaki, Miyazaki, Japan
  • Sato, Yuji, University of Miyazaki Hospital, Miyazaki, Japan
  • Ogata, Satoshi, The Japanese Society for Dialysis Therapy, Tokyo, Japan
  • Wada, Atshushi, The Japanese Society for Dialysis Therapy, Tokyo, Japan
  • Masakane, Ikuto, The Japanese Society for Dialysis Therapy, Tokyo, Japan
  • Fujimoto, Shouichi, University of Miyazaki, Miyazaki, MIYAZAKI, Japan
Background

In general Japanese with diabetes, leanness has been associated with an increased risk of all-cause mortality. However, it currently remains unclear whether BMI and age influence the prognosis of diabetic patients who start hemodialysis.

Methods

Study design: Cohort study.
Participants: Data from the national dialysis registry in 2007, including 35,415 patients on incident hemodialysis and 6,061 patients aged ≥20 years with BMI data.
Predictor: Patients were divided into 6 categories according to baseline BMI levels (Leanness: <18.5, Normal: 18.5-25, Obesity: ≥25) and the presence or absence of diabetes.
Outcomes: All-cause mortality during a 5-year follow-up.
Measurements: Hazard ratios were estimated using Cox’s model for the relationships between diabetes, BMI categories, and all-cause mortality, and adjusted for potential confounders including sex, age, systolic BP values, a previous history of cardiovascular disease, and so on. Patients with normal BMI levels without diabetes were set as our reference category. We also examined the effects of age on these relationships.

Results

Among 3239 and 2822 patients with or without diabetes, 993 and 887 patients died of all-cause mortality, respectively. Cox’s regression analysis showed that leanness, 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 two groups: younger and older than 60 years, the risk of all-cause death in the younger group was markedly increased among lean diabetic patients as well as among those with a normal BMI and diabetes, but not obesity. However, in the older group, the risk of death among diabetic patients with a normal BMI was not significantly different from that among those without diabetes. In diabetic patients of the older group, only leanness was associated with an increased risk of mortality.

Conclusion

Among incident Japanese hemodialysis patients, leanness, but not obesity, increases the risk of all-cause mortality. Particular attention must be paid to the markedly high mortality rate in lean diabetic patients regardless of age. Furthermore, diabetes may be associated with mortality in patients younger than 60 years with a normal BMI.