Inflammation and Inverse Associations of Body Mass Index and Serum Creatinine With Mortality in Hemodialysis Patients

Srinivasan Beddhu, Alfred K. Cheung, Brett Larive, Tom Greene, George A. Kaysen, Andrew S. Levey, Michael Rocco, Mark Sarnak, Robert Toto, Garabed Eknoyan

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Objective: Protein-energy wasting and inflammation are common and associated with an increased risk of mortality in hemodialysis (HD) patients. We examined the extent to which they mediate the associations of each other with death in this population. Study Design: Retrospective analysis of the Hemodialysis (HEMO) Study data. Setting: Prevalent HD patients. Participants: One-thousand HEMO study participants with data available on C-reactive protein (CRP), body mass index (BMI), and serum creatinine. Intervention: None. Main Outcome Measure: The associations of CRP, BMI, and serum creatinine with time to all-cause mortality separately and together in multivariate Cox models. Results: In 1,437 patient-years of follow-up, there were 265 (26.5%) all-cause deaths. Compared with the lowest CRP quartile, the highest quartile was associated with a hazard ratio (HR) of 2.02 (95% confidence interval [CI], 1.31-3.10) for all-cause mortality. This association of highest CRP quartile with mortality was not attenuated with further adjustment for BMI and serum creatinine (HR, 2.13; 95% CI, 1.38-3.30). When serum albumin was added to the model, the hazard of death associated with highest CRP quartile was modestly attenuated (HR, 1.88; 95% CI, 1.21-2.92). In contrast, both BMI (for each kg/m2 increase; HR, 0.94; 95% CI, 0.91-0.96 for all-cause mortality) and serum creatinine (for each mg/dL increase; HR, 0.85; 95% CI, 0.79-0.90 for all-cause mortality) had strong, independent protective effects. Further adjustment with CRP had a negligible effect on these associations. Conclusion: The associations of markers of nutrition and inflammation with mortality are largely independent of each other in HD patients.

Original languageEnglish (US)
Pages (from-to)372-380
Number of pages9
JournalJournal of Renal Nutrition
Volume17
Issue number6
DOIs
StatePublished - Nov 2007

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hemodialysis
C-reactive protein
creatinine
body mass index
Renal Dialysis
Creatinine
C-Reactive Protein
Body Mass Index
inflammation
Inflammation
confidence interval
Mortality
Confidence Intervals
Serum
protein bodies
death
Proportional Hazards Models
serum albumin
Serum Albumin
protective effect

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Urology
  • Food Science
  • Clinical Neurology

Cite this

Beddhu, S., Cheung, A. K., Larive, B., Greene, T., Kaysen, G. A., Levey, A. S., ... Eknoyan, G. (2007). Inflammation and Inverse Associations of Body Mass Index and Serum Creatinine With Mortality in Hemodialysis Patients. Journal of Renal Nutrition, 17(6), 372-380. https://doi.org/10.1053/j.jrn.2007.08.007

Inflammation and Inverse Associations of Body Mass Index and Serum Creatinine With Mortality in Hemodialysis Patients. / Beddhu, Srinivasan; Cheung, Alfred K.; Larive, Brett; Greene, Tom; Kaysen, George A.; Levey, Andrew S.; Rocco, Michael; Sarnak, Mark; Toto, Robert; Eknoyan, Garabed.

In: Journal of Renal Nutrition, Vol. 17, No. 6, 11.2007, p. 372-380.

Research output: Contribution to journalArticle

Beddhu, S, Cheung, AK, Larive, B, Greene, T, Kaysen, GA, Levey, AS, Rocco, M, Sarnak, M, Toto, R & Eknoyan, G 2007, 'Inflammation and Inverse Associations of Body Mass Index and Serum Creatinine With Mortality in Hemodialysis Patients', Journal of Renal Nutrition, vol. 17, no. 6, pp. 372-380. https://doi.org/10.1053/j.jrn.2007.08.007
Beddhu, Srinivasan ; Cheung, Alfred K. ; Larive, Brett ; Greene, Tom ; Kaysen, George A. ; Levey, Andrew S. ; Rocco, Michael ; Sarnak, Mark ; Toto, Robert ; Eknoyan, Garabed. / Inflammation and Inverse Associations of Body Mass Index and Serum Creatinine With Mortality in Hemodialysis Patients. In: Journal of Renal Nutrition. 2007 ; Vol. 17, No. 6. pp. 372-380.
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abstract = "Objective: Protein-energy wasting and inflammation are common and associated with an increased risk of mortality in hemodialysis (HD) patients. We examined the extent to which they mediate the associations of each other with death in this population. Study Design: Retrospective analysis of the Hemodialysis (HEMO) Study data. Setting: Prevalent HD patients. Participants: One-thousand HEMO study participants with data available on C-reactive protein (CRP), body mass index (BMI), and serum creatinine. Intervention: None. Main Outcome Measure: The associations of CRP, BMI, and serum creatinine with time to all-cause mortality separately and together in multivariate Cox models. Results: In 1,437 patient-years of follow-up, there were 265 (26.5{\%}) all-cause deaths. Compared with the lowest CRP quartile, the highest quartile was associated with a hazard ratio (HR) of 2.02 (95{\%} confidence interval [CI], 1.31-3.10) for all-cause mortality. This association of highest CRP quartile with mortality was not attenuated with further adjustment for BMI and serum creatinine (HR, 2.13; 95{\%} CI, 1.38-3.30). When serum albumin was added to the model, the hazard of death associated with highest CRP quartile was modestly attenuated (HR, 1.88; 95{\%} CI, 1.21-2.92). In contrast, both BMI (for each kg/m2 increase; HR, 0.94; 95{\%} CI, 0.91-0.96 for all-cause mortality) and serum creatinine (for each mg/dL increase; HR, 0.85; 95{\%} CI, 0.79-0.90 for all-cause mortality) had strong, independent protective effects. Further adjustment with CRP had a negligible effect on these associations. Conclusion: The associations of markers of nutrition and inflammation with mortality are largely independent of each other in HD patients.",
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AU - Beddhu, Srinivasan

AU - Cheung, Alfred K.

AU - Larive, Brett

AU - Greene, Tom

AU - Kaysen, George A.

AU - Levey, Andrew S.

AU - Rocco, Michael

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N2 - Objective: Protein-energy wasting and inflammation are common and associated with an increased risk of mortality in hemodialysis (HD) patients. We examined the extent to which they mediate the associations of each other with death in this population. Study Design: Retrospective analysis of the Hemodialysis (HEMO) Study data. Setting: Prevalent HD patients. Participants: One-thousand HEMO study participants with data available on C-reactive protein (CRP), body mass index (BMI), and serum creatinine. Intervention: None. Main Outcome Measure: The associations of CRP, BMI, and serum creatinine with time to all-cause mortality separately and together in multivariate Cox models. Results: In 1,437 patient-years of follow-up, there were 265 (26.5%) all-cause deaths. Compared with the lowest CRP quartile, the highest quartile was associated with a hazard ratio (HR) of 2.02 (95% confidence interval [CI], 1.31-3.10) for all-cause mortality. This association of highest CRP quartile with mortality was not attenuated with further adjustment for BMI and serum creatinine (HR, 2.13; 95% CI, 1.38-3.30). When serum albumin was added to the model, the hazard of death associated with highest CRP quartile was modestly attenuated (HR, 1.88; 95% CI, 1.21-2.92). In contrast, both BMI (for each kg/m2 increase; HR, 0.94; 95% CI, 0.91-0.96 for all-cause mortality) and serum creatinine (for each mg/dL increase; HR, 0.85; 95% CI, 0.79-0.90 for all-cause mortality) had strong, independent protective effects. Further adjustment with CRP had a negligible effect on these associations. Conclusion: The associations of markers of nutrition and inflammation with mortality are largely independent of each other in HD patients.

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