OBJECTIVE
To determine whether dry weight gain accompanied by an increase in muscle mass is
associated with a survival benefit in patients receiving maintenance hemodialysis
(HD).
PATIENTS AND METHODS
In a nationally representative 5-year cohort of 121,762 patients receiving HD 3 times
weekly from July 1, 2001, through June 30, 2006, we examined whether body mass index
(BMI) (calculated using 3-month averaged post-HD dry weight) and 3-month averaged
serum creatinine levels (a likely surrogate of muscle mass) and their changes over
time were predictive of mortality risk.
RESULTS
In the cohort, higher BMI (up to 45) and higher serum creatinine concentration were
incrementally and independently associated with greater survival, even after extensive
multivariate adjustment for available surrogates of nutritional status and inflammation.
Dry weight loss or gain over time exhibited a graded association with higher rates
of mortality or survival, respectively, as did changes in serum creatinine level over
time. Among the 50,831 patients who survived the first 6 months and who had available
data for changes in weight and creatinine level, those who lost weight but had an
increased serum creatinine level had a greater survival rate than those who gained
weight but had a decreased creatinine level. These associations appeared consistent
across different demographic groups of patients receiving HD.
CONCLUSION
In patients receiving long-term HD, larger body size with more muscle mass appears
associated with a higher survival rate. A discordant muscle gain with weight loss
over time may confer more survival benefit than weight gain while losing muscle. Controlled
trials of muscle-gaining interventions in patients receiving HD are warranted.
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Article Info
Footnotes
The study was supported by Dr Kalantar-Zadeh's research grants from the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health ( R01 DK078106 ), the American Heart Association ( 0655776Y ), and Davita Clinical Research (DCR), as well as a philanthropic grant from Mr Harold Simmons and an additional DCR grant for the Division of Nephrology & Hypertension at Harbor-UCLA Medical Center.
We thank Mr Robert Lehn at DaVita Laboratories in Deland, FL, and Mr Joe Weldon, from DaVita Informatics, for providing the national database, and Mr Chris Rucker and Ms Beth Bennett from DaVita Clinical Research for their continued support.
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