Mortality Predictability of Body Size and Muscle Mass Surrogates in Asian vs White and African American Hemodialysis Patients

• Published in: Mayo Clinic proceedings Vol. 88; no. 5; pp. 479 - 486
• Main Authors: Park, Jongha, MD, Jin, Dong Chan, MD, Molnar, Miklos Z., MD, PhD, Dukkipati, Ramanath, MD, Kim, Yong-Lim, MD, Jing, Jennie, MS, Levin, Nathan W., MD, Nissenson, Allen R., MD, Lee, Jong Soo, MD, Kalantar-Zadeh, Kamyar, MD, MPH, PhD
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01.05.2013; Elsevier, Inc; Elsevier Limited
• Subjects: Aged; Asian People; Biomarkers; Black or African American; Body Mass Index; Body Size; Creatinine; Demographic aspects; Female; Health aspects; Hemodialysis patients; Humans; Internal Medicine; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - mortality; Male; Middle Aged; Obesity - complications; Obesity - mortality; Racial Groups; Renal Dialysis - mortality; Republic of Korea - epidemiology; Republic of Korea - ethnology; Risk Factors; Survival Analysis; United States - epidemiology; United States - ethnology; White People; United States; Republic of Korea; ESRD; US Renal Data System; PEW; normalized protein nitrogen appearance; body mass index; nPNA; HR; end-stage renal disease; USRDS; hemodialysis; hazard ratio; HD; protein-energy wasting; BMI
• ISSN: 0025-6196; 1942-5546
• DOI: 10.1016/j.mayocp.2013.01.025

Abstract Objective To determine whether the association of body size and muscle mass with survival among patients undergoing long-term hemodialysis (HD) is consistent across race, especially in East Asian vs white and African American patients. Patients and Methods Using data from 20,818 patients from South Korea who underwent HD from February 1, 2001, to June 30, 2009, and 20,000 matched patients from the United States (10,000 whites and 10,000 African Americans) who underwent HD from July 1, 2001, to June 30, 2006, we compared mortality associations of baseline body mass index (BMI) and serum creatinine level as likely surrogates of obesity and muscle mass across the 3 races. Results In Korean HD patients, higher BMI together with higher serum creatinine levels were associated with greater survival, as previously reported from US and European studies. In the matched cohort (10,000 patients from each of the 3 races), mortality risks were lower across higher BMI and serum creatinine levels, and these associations were similar in all 3 races (reference groups: patients with BMI >25.0 kg/m2 or serum creatinine >12 mg/dL in each race). White, African American, and Korean patients with BMI levels of 18.5 kg/m2 or less (underweight) had 78%, 79%, and 57% higher mortality risk, respectively, and white, African American, and Korean patients with serum creatinine levels of 6.0 mg/dL or less had 108%, 87%, and 78% higher mortality, respectively. Conclusion This study shows that race does not modify the association of higher body size and muscle mass with greater survival in HD patients. Given the consistency of the obesity paradox, which may be related to a mitigated effect of protein-energy wasting on mortality irrespective of racial disparities, nutritional support to improve survival should be tested in HD patients of all races.