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

ABSTRACT: 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.Retrospective cohort study.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.Race and BMI.All-cause mortality.Patients had a mean age of 62 ± 15 (standard deviation) years and included 45% women and 45% patients with diabetes. Across 10 a priori-selected 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.Race and ethnicity categories were based on self-identified data.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.

SUBMITTER: Ricks J

PROVIDER: S-EPMC3183288 | biostudies-literature | 2011 Oct

REPOSITORIES: biostudies-literature

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

Ricks Joni J Molnar Miklos Z MZ Kovesdy Csaba P CP Kopple Joel D JD Norris Keith C KC Mehrotra Rajnish R Nissenson Allen R AR Arah Onyebuchi A OA Greenland Sander S Kalantar-Zadeh Kamyar K

American journal of kidney diseases : the official journal of the National Kidney Foundation 20110612 4

<h4>Background</h4>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.<h4>Study design</h4>Retrospective cohort study.<h4>Setting & participants</h4>We examined a 6-year (2001-2007) cohort of 109,605 maintenance ...[more]

PMID: 21658829

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Project description:BackgroundEvidence exists for racial/ethnic differences in left ventricular mass index (LVMI). How this translates to future cardiovascular disease (CVD) events is unknown.HypothesisThe impact of racial/ethnic differences in LVMI on incident cardiovascular outcomes could have potential implications for the optimization of risk stratification strategies.MethodsUsing the prospectively collected database of the Multi-Ethnic Study of Atherosclerosis (MESA) involving 4 racial/ethnic groups (non-Hispanic Whites, Chinese, Blacks, and Hispanics) free of CVD at baseline, we assessed for racial/ethnic differences in the relationship between LVMI and incident CVD using a Cox model.Results5004 participants (mean age, 62 ± 10 years; 48% male) were included in this study. After an average follow-up of 10.2 years, 369 (7.4%) CVD events occurred. Significant racial/ethnic differences existed in the relationship between LVMI and incident CVD (P for interaction = 0.04). Notably, the relationship was strongest for Chinese (HR per 10-unit increase in LVMI: 1.7, 95% CI: 1.1-2.8) and Hispanics (HR per 10-unit increase in LVMI: 1.9, 95% CI: 1.5-2.2). Non-Hispanic Whites demonstrated the lowest relationship (HR: 1.3, 95% CI: 1.1-1.5). LVMI values of 36.9 g/m2.7 , 31.8 g/m2.7 , 39.9 g/m2.7 , and 41.7 g/m2.7 were identified as optimal cutpoints for defining left ventricular hypertrophy (LVH) for non-Hispanic Whites, Chinese, Blacks, and Hispanics, respectively. In secondary analysis of LVH (vs no LVH) using these optimal cutpoints, we found a similar pattern of association as above (P for interaction = 0.04). For example, compared with those without LVH, Chinese with LVH had HR: 5.3, 95% CI: 1.6-17, whereas non-Hispanic Whites with LVH had HR: 1.6, 95% CI: 1.2-2.1 for CVD events.ConclusionsAmong 4 races/ethnicities studied, LVMI has more prognostic utility predicting future CVD events for Chinese and Hispanics and is least significant for non-Hispanic Whites.

Dataset Information

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

Publications

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

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