Association of body weight changes with mortality in incident hemodialysis patients

Tae Ik Chang, Vyvian Ngo, Elani Streja, Jason A. Chou, Amanda R. Tortorici, Tae Hee Kim, Tae Woo Kim, Melissa Soohoo, Daniel Gillen, Connie M. Rhee, Csaba Kovesdy, Kamyar Kalantar-Zadeh

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Abstract

Background. Incident hemodialysis patients may experience rapid weight loss in the first few months of starting dialysis. However, trends in weight changes over time and their associations with survival have not yet been characterized in this population. Methods. In a large contemporary US cohort of 58 106 patients who initiated hemodialysis during 1 January 2007-31 December 2011 and survived the first year of dialysis, we observed trends in weight changes during the first year of treatment and then examined the association of post-dialysis weight changes with all-cause mortality. Results. Patients- post-dialysis weights rapidly decreased and reached a nadir at the 5th month of dialysis with an average decline of 2% from baseline, whereas obese patients (body mass index ≥30 kg/m2) did not reach a nadir and lost ∼3.8% of their weight by the 12th month. Compared with the reference group (-2 to 2% changes in weight), the death hazard ratios (HRs) of patients with -6 to -2% and greater than or equal to -6% weight loss during the first 5 months were 1.08 (95% confidence interval, 1.02-1.14) and 1.14 (1.07-1.22), respectively. Moreover, the death HRs with 2-6% and -6% weight gain during the 5th to 12th months were 0.91 (0.85-0.97) and 0.92 (0.86-0.99), respectively. Conclusions. In patients who survive the first year of hemodialysis, a decline in post-dialysis weight is observed and reaches a nadir at the 5th month. An incrementally larger weight loss during the first 12 months is associated with higher death risk, whereas weight gain is associated with greater survival during the 5th to 12th month but not in the first 5 months of dialysis therapy.

Original languageEnglish (US)
Pages (from-to)1549-1558
Number of pages10
JournalNephrology Dialysis Transplantation
Volume32
Issue number9
DOIs
StatePublished - Jan 1 2017

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Body Weight Changes
Renal Dialysis
Dialysis
Weights and Measures
Mortality
Weight Loss
Weight Gain
Survival
Body Mass Index
Confidence Intervals
Therapeutics
Population

All Science Journal Classification (ASJC) codes

  • Nephrology
  • Transplantation

Cite this

Chang, T. I., Ngo, V., Streja, E., Chou, J. A., Tortorici, A. R., Kim, T. H., ... Kalantar-Zadeh, K. (2017). Association of body weight changes with mortality in incident hemodialysis patients. Nephrology Dialysis Transplantation, 32(9), 1549-1558. https://doi.org/10.1093/ndt/gfw373

Association of body weight changes with mortality in incident hemodialysis patients. / Chang, Tae Ik; Ngo, Vyvian; Streja, Elani; Chou, Jason A.; Tortorici, Amanda R.; Kim, Tae Hee; Kim, Tae Woo; Soohoo, Melissa; Gillen, Daniel; Rhee, Connie M.; Kovesdy, Csaba; Kalantar-Zadeh, Kamyar.

In: Nephrology Dialysis Transplantation, Vol. 32, No. 9, 01.01.2017, p. 1549-1558.

Research output: Contribution to journalArticle

Chang, TI, Ngo, V, Streja, E, Chou, JA, Tortorici, AR, Kim, TH, Kim, TW, Soohoo, M, Gillen, D, Rhee, CM, Kovesdy, C & Kalantar-Zadeh, K 2017, 'Association of body weight changes with mortality in incident hemodialysis patients', Nephrology Dialysis Transplantation, vol. 32, no. 9, pp. 1549-1558. https://doi.org/10.1093/ndt/gfw373
Chang, Tae Ik ; Ngo, Vyvian ; Streja, Elani ; Chou, Jason A. ; Tortorici, Amanda R. ; Kim, Tae Hee ; Kim, Tae Woo ; Soohoo, Melissa ; Gillen, Daniel ; Rhee, Connie M. ; Kovesdy, Csaba ; Kalantar-Zadeh, Kamyar. / Association of body weight changes with mortality in incident hemodialysis patients. In: Nephrology Dialysis Transplantation. 2017 ; Vol. 32, No. 9. pp. 1549-1558.
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abstract = "Background. Incident hemodialysis patients may experience rapid weight loss in the first few months of starting dialysis. However, trends in weight changes over time and their associations with survival have not yet been characterized in this population. Methods. In a large contemporary US cohort of 58 106 patients who initiated hemodialysis during 1 January 2007-31 December 2011 and survived the first year of dialysis, we observed trends in weight changes during the first year of treatment and then examined the association of post-dialysis weight changes with all-cause mortality. Results. Patients- post-dialysis weights rapidly decreased and reached a nadir at the 5th month of dialysis with an average decline of 2{\%} from baseline, whereas obese patients (body mass index ≥30 kg/m2) did not reach a nadir and lost ∼3.8{\%} of their weight by the 12th month. Compared with the reference group (-2 to 2{\%} changes in weight), the death hazard ratios (HRs) of patients with -6 to -2{\%} and greater than or equal to -6{\%} weight loss during the first 5 months were 1.08 (95{\%} confidence interval, 1.02-1.14) and 1.14 (1.07-1.22), respectively. Moreover, the death HRs with 2-6{\%} and -6{\%} weight gain during the 5th to 12th months were 0.91 (0.85-0.97) and 0.92 (0.86-0.99), respectively. Conclusions. In patients who survive the first year of hemodialysis, a decline in post-dialysis weight is observed and reaches a nadir at the 5th month. An incrementally larger weight loss during the first 12 months is associated with higher death risk, whereas weight gain is associated with greater survival during the 5th to 12th month but not in the first 5 months of dialysis therapy.",
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AU - Chang, Tae Ik

AU - Ngo, Vyvian

AU - Streja, Elani

AU - Chou, Jason A.

AU - Tortorici, Amanda R.

AU - Kim, Tae Hee

AU - Kim, Tae Woo

AU - Soohoo, Melissa

AU - Gillen, Daniel

AU - Rhee, Connie M.

AU - Kovesdy, Csaba

AU - Kalantar-Zadeh, Kamyar

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background. Incident hemodialysis patients may experience rapid weight loss in the first few months of starting dialysis. However, trends in weight changes over time and their associations with survival have not yet been characterized in this population. Methods. In a large contemporary US cohort of 58 106 patients who initiated hemodialysis during 1 January 2007-31 December 2011 and survived the first year of dialysis, we observed trends in weight changes during the first year of treatment and then examined the association of post-dialysis weight changes with all-cause mortality. Results. Patients- post-dialysis weights rapidly decreased and reached a nadir at the 5th month of dialysis with an average decline of 2% from baseline, whereas obese patients (body mass index ≥30 kg/m2) did not reach a nadir and lost ∼3.8% of their weight by the 12th month. Compared with the reference group (-2 to 2% changes in weight), the death hazard ratios (HRs) of patients with -6 to -2% and greater than or equal to -6% weight loss during the first 5 months were 1.08 (95% confidence interval, 1.02-1.14) and 1.14 (1.07-1.22), respectively. Moreover, the death HRs with 2-6% and -6% weight gain during the 5th to 12th months were 0.91 (0.85-0.97) and 0.92 (0.86-0.99), respectively. Conclusions. In patients who survive the first year of hemodialysis, a decline in post-dialysis weight is observed and reaches a nadir at the 5th month. An incrementally larger weight loss during the first 12 months is associated with higher death risk, whereas weight gain is associated with greater survival during the 5th to 12th month but not in the first 5 months of dialysis therapy.

AB - Background. Incident hemodialysis patients may experience rapid weight loss in the first few months of starting dialysis. However, trends in weight changes over time and their associations with survival have not yet been characterized in this population. Methods. In a large contemporary US cohort of 58 106 patients who initiated hemodialysis during 1 January 2007-31 December 2011 and survived the first year of dialysis, we observed trends in weight changes during the first year of treatment and then examined the association of post-dialysis weight changes with all-cause mortality. Results. Patients- post-dialysis weights rapidly decreased and reached a nadir at the 5th month of dialysis with an average decline of 2% from baseline, whereas obese patients (body mass index ≥30 kg/m2) did not reach a nadir and lost ∼3.8% of their weight by the 12th month. Compared with the reference group (-2 to 2% changes in weight), the death hazard ratios (HRs) of patients with -6 to -2% and greater than or equal to -6% weight loss during the first 5 months were 1.08 (95% confidence interval, 1.02-1.14) and 1.14 (1.07-1.22), respectively. Moreover, the death HRs with 2-6% and -6% weight gain during the 5th to 12th months were 0.91 (0.85-0.97) and 0.92 (0.86-0.99), respectively. Conclusions. In patients who survive the first year of hemodialysis, a decline in post-dialysis weight is observed and reaches a nadir at the 5th month. An incrementally larger weight loss during the first 12 months is associated with higher death risk, whereas weight gain is associated with greater survival during the 5th to 12th month but not in the first 5 months of dialysis therapy.

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