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The impact of disease severity on paradoxical association between body mass index and mortality in patients with acute kidney injury undergoing continuous renal replacement therapy

 Hyoungnae Kim  ;  Hyunwook Kim  ;  Misol Lee  ;  Min-Uk Cha  ;  Ki Heon Nam  ;  Seong Yeong An  ;  Su-Young Jung  ;  Jong Hyun Jhee  ;  Seohyun Park  ;  Hae-Ryong Yun  ;  Youn Kyung Kee  ;  Hyung Jung Oh  ;  Jung Tak Park  ;  Tae Ik Chang  ;  Tae-Hyun Yoo  ;  Shin-Wook Kang  ;  Seung Hyeok Han 
 BMC NEPHROLOGY, Vol.19(1) : 32, 2018 
Journal Title
Issue Date
Acute kidney injury ; Body mass index ; Continuous renal replacement therapy ; Disease severity ; Mortality
BACKGROUND: Association between high body mass index (BMI) and survival benefit is confounded by comorbid conditions such as nutritional status and inflammation. Patients with acute kidney injury (AKI), particularly those receiving continuous renal replacement therapy (CRRT), are highly catabolic and more susceptible to loss of energy. Herein, we evaluated whether disease severity can modify the relationship between BMI and mortality. METHODS: We conducted an observational study in 1144 patients who had undergone CRRT owing to various causes of AKI between 2010 and 2014. Patients were categorized into four groups; underweight (< 18.5 kg/m(2)), normal (18.5-22.99 kg/m(2)), overweight (23.0-24.99 kg/m(2)), and obesity (>/=25 kg/m(2)) according to BMI classification by the Committee of Clinical Practice Guidelines and Korean Society for the Study of Obesity. More severe disease was defined as sepsis-related organ failure assessment (SOFA) score of >/= a median value of 12. The study endpoint was death that occurred within 30 days after the initiation of CRRT. RESULTS: The mean age was 63.2 years and 439 (38.4%) were females. The median BMI was 23.6 (20.9-26.2) kg/m(2). The obese group were younger and higher SOFA score than normal BMI group. In a multivariable Cox regression analysis, we found a significant interaction between BMI and SOFA score (P < 0.001). Furthermore, obese patients were significantly associated with a lower risk of death as compared to normal BMI group after adjusting confounding factors [hazard ratio (HR), 0.81; 95% confidence interval (CI), 0.68-0.97; P = 0.03]. This association was only evident among patients with high severity (HR, 0.61; 95% CI, 0.48-0.76, P < 0.001). In contrast, in those with low severity, survival benefit of high BMI was lost, whereas underweight was associated with an increased risk of death (HR, 1.74; 95% CI, 1.16-2.60; P = 0.007). CONCLUSION: In this study, we found a survival benefit of high BMI in AKI patients undergoing CRRT, particularly in those with more disease severity; the effect was not observed in those with less disease severity.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Shin Wook(강신욱) ORCID logo https://orcid.org/0000-0002-5677-4756
Kee, Youn Kyung(기연경)
Kim, Hyun Wook(김현욱) ORCID logo https://orcid.org/0000-0002-4274-7562
Kim, Hyoung Rae(김형래)
Nam, Ki Heon(남기헌) ORCID logo https://orcid.org/0000-0001-7312-7027
Park, Seo Hyun(박서현)
Park, Jung Tak(박정탁) ORCID logo https://orcid.org/0000-0002-2325-8982
An, Seong Yeong(안성영)
Yoo, Tae Hyun(유태현) ORCID logo https://orcid.org/0000-0002-9183-4507
Yun, Hae Ryong(윤해룡) ORCID logo https://orcid.org/0000-0002-7038-0251
Lee, Mi Sol(이미솔)
Jung, Su Young(정수영)
Jhee, Jong Hyun(지종현)
Cha, Min Uk(차민욱)
Han, Seung Hyeok(한승혁) ORCID logo https://orcid.org/0000-0001-7923-5635
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