Racial and ethnic differences in the association of body mass index and survival in maintenance hemodialysis patients

Joni Ricks, Miklos Z. Molnar, Csaba Kovesdy, Joel D. Kopple, Keith C. Norris, Rajnish Mehrotra, Allen R. Nissenson, Onyebuchi A. Arah, Sander Greenland, Kamyar Kalantar-Zadeh

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

Background: In maintenance hemodialysis (HD) patients, overweight and obesity are associated with survival advantages. Given the greater survival of maintenance HD patients who are minorities, we hypothesized that increased body mass index (BMI) is associated more strongly with lower mortality in blacks and Hispanics relative to non-Hispanic whites. Study Design: Retrospective cohort study. Setting & Participants: We examined a 6-year (2001-2007) cohort of 109,605 maintenance HD patients including 39,090 blacks, 17,417 Hispanics, and 53,098 non-Hispanic white maintenance HD outpatients from DaVita dialysis clinics. Cox proportional hazards models examined the association between BMI and survival. Predictors: Race and BMI. Outcomes: All-cause mortality. Results: Patients had a mean age of 62 ± 15 (standard deviation) years and included 45% women and 45% patients with diabetes. Across 10 a prioriselected BMI categories (<18-<40 kg/m 2), higher BMI was associated with greater survival in all 3 racial/ethnic groups. However, Hispanic and black patients experienced higher survival gains compared with non-Hispanic whites across higher BMI categories. Hispanics and blacks in the <40-kg/m 2 category had the largest adjusted decrease in death HR with increasing BMI (0.57 [95% CI, 0.49-0.68] and 0.63 [95% CI, 0.58-0.70], respectively) compared with non-Hispanic whites in the 23- to 25-kg/m 2 group (reference category). In linear models, although the inverse BMI-mortality association was observed for all subgroups, overall black maintenance HD patients showed the largest consistent decrease in death HR with increasing BMI. Limitations: Race and ethnicity categories were based on self-identified data. Conclusions: Whereas the survival advantage of high BMI is consistent across all racial/ethnic groups, black maintenance HD patients had the strongest and most consistent association of higher BMI with improved survival.

Original languageEnglish (US)
Pages (from-to)574-582
Number of pages9
JournalAmerican Journal of Kidney Diseases
Volume58
Issue number4
DOIs
StatePublished - Oct 1 2011

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Renal Dialysis
Body Mass Index
Maintenance
Survival
Hispanic Americans
Ethnic Groups
Mortality
Proportional Hazards Models
Dialysis
Linear Models
Cohort Studies
Outpatients
Retrospective Studies
Obesity

All Science Journal Classification (ASJC) codes

  • Nephrology

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Racial and ethnic differences in the association of body mass index and survival in maintenance hemodialysis patients. / Ricks, Joni; Molnar, Miklos Z.; Kovesdy, Csaba; Kopple, Joel D.; Norris, Keith C.; Mehrotra, Rajnish; Nissenson, Allen R.; Arah, Onyebuchi A.; Greenland, Sander; Kalantar-Zadeh, Kamyar.

In: American Journal of Kidney Diseases, Vol. 58, No. 4, 01.10.2011, p. 574-582.

Research output: Contribution to journalArticle

Ricks, J, Molnar, MZ, Kovesdy, C, Kopple, JD, Norris, KC, Mehrotra, R, Nissenson, AR, Arah, OA, Greenland, S & Kalantar-Zadeh, K 2011, 'Racial and ethnic differences in the association of body mass index and survival in maintenance hemodialysis patients', American Journal of Kidney Diseases, vol. 58, no. 4, pp. 574-582. https://doi.org/10.1053/j.ajkd.2011.03.023
Ricks, Joni ; Molnar, Miklos Z. ; Kovesdy, Csaba ; Kopple, Joel D. ; Norris, Keith C. ; Mehrotra, Rajnish ; Nissenson, Allen R. ; Arah, Onyebuchi A. ; Greenland, Sander ; Kalantar-Zadeh, Kamyar. / Racial and ethnic differences in the association of body mass index and survival in maintenance hemodialysis patients. In: American Journal of Kidney Diseases. 2011 ; Vol. 58, No. 4. pp. 574-582.
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abstract = "Background: In maintenance hemodialysis (HD) patients, overweight and obesity are associated with survival advantages. Given the greater survival of maintenance HD patients who are minorities, we hypothesized that increased body mass index (BMI) is associated more strongly with lower mortality in blacks and Hispanics relative to non-Hispanic whites. Study Design: Retrospective cohort study. Setting & Participants: We examined a 6-year (2001-2007) cohort of 109,605 maintenance HD patients including 39,090 blacks, 17,417 Hispanics, and 53,098 non-Hispanic white maintenance HD outpatients from DaVita dialysis clinics. Cox proportional hazards models examined the association between BMI and survival. Predictors: Race and BMI. Outcomes: All-cause mortality. Results: Patients had a mean age of 62 ± 15 (standard deviation) years and included 45{\%} women and 45{\%} patients with diabetes. Across 10 a prioriselected BMI categories (<18-<40 kg/m 2), higher BMI was associated with greater survival in all 3 racial/ethnic groups. However, Hispanic and black patients experienced higher survival gains compared with non-Hispanic whites across higher BMI categories. Hispanics and blacks in the <40-kg/m 2 category had the largest adjusted decrease in death HR with increasing BMI (0.57 [95{\%} CI, 0.49-0.68] and 0.63 [95{\%} CI, 0.58-0.70], respectively) compared with non-Hispanic whites in the 23- to 25-kg/m 2 group (reference category). In linear models, although the inverse BMI-mortality association was observed for all subgroups, overall black maintenance HD patients showed the largest consistent decrease in death HR with increasing BMI. Limitations: Race and ethnicity categories were based on self-identified data. Conclusions: Whereas the survival advantage of high BMI is consistent across all racial/ethnic groups, black maintenance HD patients had the strongest and most consistent association of higher BMI with improved survival.",
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AU - Ricks, Joni

AU - Molnar, Miklos Z.

AU - Kovesdy, Csaba

AU - Kopple, Joel D.

AU - Norris, Keith C.

AU - Mehrotra, Rajnish

AU - Nissenson, Allen R.

AU - Arah, Onyebuchi A.

AU - Greenland, Sander

AU - Kalantar-Zadeh, Kamyar

PY - 2011/10/1

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N2 - Background: In maintenance hemodialysis (HD) patients, overweight and obesity are associated with survival advantages. Given the greater survival of maintenance HD patients who are minorities, we hypothesized that increased body mass index (BMI) is associated more strongly with lower mortality in blacks and Hispanics relative to non-Hispanic whites. Study Design: Retrospective cohort study. Setting & Participants: We examined a 6-year (2001-2007) cohort of 109,605 maintenance HD patients including 39,090 blacks, 17,417 Hispanics, and 53,098 non-Hispanic white maintenance HD outpatients from DaVita dialysis clinics. Cox proportional hazards models examined the association between BMI and survival. Predictors: Race and BMI. Outcomes: All-cause mortality. Results: Patients had a mean age of 62 ± 15 (standard deviation) years and included 45% women and 45% patients with diabetes. Across 10 a prioriselected BMI categories (<18-<40 kg/m 2), higher BMI was associated with greater survival in all 3 racial/ethnic groups. However, Hispanic and black patients experienced higher survival gains compared with non-Hispanic whites across higher BMI categories. Hispanics and blacks in the <40-kg/m 2 category had the largest adjusted decrease in death HR with increasing BMI (0.57 [95% CI, 0.49-0.68] and 0.63 [95% CI, 0.58-0.70], respectively) compared with non-Hispanic whites in the 23- to 25-kg/m 2 group (reference category). In linear models, although the inverse BMI-mortality association was observed for all subgroups, overall black maintenance HD patients showed the largest consistent decrease in death HR with increasing BMI. Limitations: Race and ethnicity categories were based on self-identified data. Conclusions: Whereas the survival advantage of high BMI is consistent across all racial/ethnic groups, black maintenance HD patients had the strongest and most consistent association of higher BMI with improved survival.

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