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Abstract: FR-PO840

The Association Between Race/Ethnicity and Mortality Is Modified by BMI

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Kleine, Carola-Ellen, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States
  • Moradi, Hamid, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States
  • Park, Christina, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States
  • Hsiung, Jui-Ting, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States
  • Rhee, Connie, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States
  • Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Kalantar-Zadeh, Kamyar, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States
  • Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States
Background

African-Americans (AA) and Hispanics have better survival rates once on hemodialysis (HD). This phenomenon is known as “racial paradox”. Besides, obese HD patients might have a survival benefit, too. Therefore, we aimed to examine if BMI is an effect modifier of the race/ethnicity-mortality association.

Methods

We retrospectively examined a cohort of 140,817 HD patients from a large dialysis organization in 2007 to 2011 who had known race/ethnicity and recorded BMI value. Patients were grouped according to their self-identified race/ethnicity. We explored the effect modification of BMI on the association between AA vs White, Hispanic vs. White, Asian vs. White and White vs non-White and all-cause mortality with adjustments for case-mix variables and laboratory markers of malnutrition and inflammation by using restricted cubic spline models, which splined the impact over continuous BMI.

Results

The cohort consisted of 29% AAs, 3% Asians, 14% Hispanics, 50% Whites and 3% others with a mean age of 64±15 years and mean BMI value of 28.2±7.3 kg/m2. We found a survival benefit of both AA and Hispanic patients when compared to White patients. This survival benefit was more observed in those with higher BMI and attenuated for low BMI patients. We observed a similar trend for Asians (reference Whites), however it did not reach statistical significance for higher BMI values. For Whites, the mortality association mirrored the findings in non-Whites. [figure1].

Conclusion

Among HD patients, BMI is an effect modifier of the race/ethnicity-mortality association.

Funding

  • NIDDK Support