Impact of Percent Body Fat on All-Cause Mortality among Adequate Dialysis Patients with and without Insulin Resistance

TY - JOUR

T1 - Impact of Percent Body Fat on All-Cause Mortality among Adequate Dialysis Patients with and without Insulin Resistance

T2 - A Multi-Center Prospective Cohort Study

AU - Duong, Tuyen Van

AU - Wong, Te Chih

AU - Chen, Hsi Hsien

AU - Chen, Tso Hsiao

AU - Hsu, Yung Ho

AU - Peng, Sheng Jeng

AU - Kuo, Ko Lin

AU - Liu, Hsiang Chung

AU - Lin, En Tzu

AU - Yang, Shwu Huey

PY - 2019/6/9

Y1 - 2019/6/9

N2 - The association between body fat and mortality in hemodialysis patients remains controversial. We examined the effect of percent body fat (PBF) on all-cause mortality among adequate hemodialysis patients with and without insulin resistance (IR). A prospective cohort study was conducted on 365 adequate hemodialysis patients (equilibrated Kt/V ≥ 1.2) from seven hospitals. Patients' characteristics and clinical and biochemical parameters were assessed at baseline between September 2013 and April 2017. Patients were followed up for all-cause mortality until April 2018. The median value of homeostatic model assessment (HOMA-IR) was used to classify IR. Cox proportional hazard models were utilized to examine predictors of all-cause mortality. During 1.4 (1.0-3.2) years of follow-up, 46 patients died. In patients with IR (HOMA-IR ≥ 5.18), PBF was significantly higher in the survival group than in the death group (31.3 ± 9.0 vs. 25.4 ± 8.2, p = 0.005). After controlling for confounding factors, PBF was significantly associated with lower risk for all-cause mortality in patients with IR (hazard ratio, 0.94; 95% confidence interval, 0.89-1.00; p = 0.033). The association was not observed in patients without IR. In conclusion, percent body fat shows a protective effect on survival in hemodialysis patients with IR.

AB - The association between body fat and mortality in hemodialysis patients remains controversial. We examined the effect of percent body fat (PBF) on all-cause mortality among adequate hemodialysis patients with and without insulin resistance (IR). A prospective cohort study was conducted on 365 adequate hemodialysis patients (equilibrated Kt/V ≥ 1.2) from seven hospitals. Patients' characteristics and clinical and biochemical parameters were assessed at baseline between September 2013 and April 2017. Patients were followed up for all-cause mortality until April 2018. The median value of homeostatic model assessment (HOMA-IR) was used to classify IR. Cox proportional hazard models were utilized to examine predictors of all-cause mortality. During 1.4 (1.0-3.2) years of follow-up, 46 patients died. In patients with IR (HOMA-IR ≥ 5.18), PBF was significantly higher in the survival group than in the death group (31.3 ± 9.0 vs. 25.4 ± 8.2, p = 0.005). After controlling for confounding factors, PBF was significantly associated with lower risk for all-cause mortality in patients with IR (hazard ratio, 0.94; 95% confidence interval, 0.89-1.00; p = 0.033). The association was not observed in patients without IR. In conclusion, percent body fat shows a protective effect on survival in hemodialysis patients with IR.

KW - all-cause mortality

KW - dialysis adequacy

KW - hemodialysis

KW - HOMA-IR

KW - insulin resistance

KW - mortality

KW - multi-center

KW - obesity

KW - percent body fat

KW - survival

UR - http://www.scopus.com/inward/record.url?scp=85067830451&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85067830451&partnerID=8YFLogxK

U2 - 10.3390/nu11061304

DO - 10.3390/nu11061304

M3 - Article

VL - 11

JO - Nutrients

JF - Nutrients

SN - 2072-6643

IS - 6

ER -