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ABSTRACT: Background
Lean body mass (LBM) represents the "fat-free" muscle mass in hemodialysis (HD) patients and is an important nutritional measure. Previous studies have found that both higher LBM and body mass index (BMI) were related to greater survival in HD patients. Additional studies have shown differences in survival across racial-ethnic groups of HD patients. However, the association of LBM and mortality across racial-ethnic subgroups has not been examined.Objective
We hypothesize that racial differences in LBM affect the mortality in HD patients.Setting and subjects
Chronic HD patients from a large dialysis organization in the United States.Predictors
Estimated LBM (eLBM), self-identified racial subgroups.Main outcome measure
5-year survival.Study design
We examined the association between baseline eLBM and survival using Cox proportional hazard models adjusted for demographics, comorbidities, and laboratory measures. Associations were examined across subgroups of race-ethnicity (non-Hispanic white, African American, and Hispanic) and BMI.Results
The final cohort included 117,683 HD patients, who were 62 ± 15 (mean ± standard deviation) years old, 43% women and 59% with diabetes mellitus. Higher eLBM was linearly associated with lower mortality. Compared with the reference group (48.4-<50.5 kg), patients with the lowest eLBM (<41.3 kg) had a 1.4-fold higher risk of mortality (hazard ratio: 1.37; 95% confidence interval: 1.30-1.44) in the fully adjusted model. A similar linear association was seen among patients with BMI < 35 kg/m(2) and in non-Hispanic whites and African American subgroups. However, higher eLBM was not associated with improved survival in Hispanic patients or patients with BMI ≥ 35 kg/m(2).Limitation
Potential residual confounding.Conclusions
Higher eLBM is associated with a lower mortality risk in HD patients, especially among non-Hispanic white and African American groups. Hispanic patients do not demonstrate a similar inverse relationship. The association between LBM and mortality among different racial groups of HD patients deserves additional study.
SUBMITTER: Wang J
PROVIDER: S-EPMC4706466 | biostudies-literature | 2016 Jan
REPOSITORIES: biostudies-literature
Wang Jialin J Streja Elani E Rhee Connie M CM Soohoo Melissa M Feng Mingliang M Brunelli Steven M SM Kovesdy Csaba P CP Gillen Daniel D Kalantar-Zadeh Kamyar K Chen Joline L T JL
Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation 20151021 1
<h4>Background</h4>Lean body mass (LBM) represents the "fat-free" muscle mass in hemodialysis (HD) patients and is an important nutritional measure. Previous studies have found that both higher LBM and body mass index (BMI) were related to greater survival in HD patients. Additional studies have shown differences in survival across racial-ethnic groups of HD patients. However, the association of LBM and mortality across racial-ethnic subgroups has not been examined.<h4>Objective</h4>We hypothesi ...[more]