OVERWEIGHT AS ANOTHER NUTRITIONAL RISK FACTOR FOR THE LONG-TERM SURVIVAL OF NONDIABETIC HEMODIALYSIS-PATIENTS

Objective: Studies were performed to investigate the association of th e body mass index (BMI) with long-term survival of non-diabetic hemodi alysis patients who were monitored for up to 12 years. Methods: In 116 patients having undergone hemodialysis in 1984, a Kaplan-Meier surviv al analysis was performed, and a proportional hazard model was applied to calculate the relative risk of mortality in body mass index quinti les. Results: Those patients with BMI of less than 16.9 kg/m(2) and mo re than 23.0 kg/m(2) showed lowered survival relative to the patients with BMI of 17.0-18.9 kg/m(2). A proportional hazard model revealed th at the patients with BMI of less than 16.9 kg/m(2) had the highest ris k of mortality independent of age, gender, smoking, duration of hemodi alysis, serum albumin, blood pressure and urea reduction rate. Those p atients with BMI of over 19.0 kg/m(2) also had a high risk of mortalit y which was progressively elevated with increasing BMI. This higher ri sk of mortality in those patients with high BMI was associated with su ch atherosclerotic risk factors as low HDL-cholesterol and high total- HDL-cholesterol ratio. The number of hospitalizations showed a similar trend to mortality in the body mass index quintiles. The survivors lo st their body weight slightly but significantly for 12 years, although there were no significant changes in serum albumin and creatinine. Se rum albumin, prealbumin and IGF-1 were within normal range in 1996, su ggesting that the survivors did not exhibit severe malnutrition. Concl usions: These results suggest that long-term survival could be attaine d by patients with relatively low BMI who have no serious nutritional problems. Nutritional intervention might be required in the overweight patients, in addition to extremely lean patients.