BMI and its association with death and the initiation of renal replacement therapy (RRT) in a cohort of patients with chronic kidney disease (CKD)

BACKGROUND: A survival advantage associated with obesity has often been described in dialysis patients. The association of higher body mass index (BMI) with mortality and renal replacement therapy (RRT) in preterminal chronic kidney disease (CKD) patients has not been established. METHODS: Subjects were patients with pre-terminal CKD who were recruited to the CKD.QLD registry. BMI at time of consent was grouped as normal (BMI 18.5–24.9 kg/m(2)), overweight (BMI 25–29.9 kg/m(2)), mild obesity (BMI 30–34.9 kg/m(2)) and moderate obesity+ (BMI ≥ 35 kg/m(2)) as defined by WHO criteria. The associations of BMI categories with mortality and starting RRT were analysed. RESULTS: The cohort consisted of 3344 CKD patients, of whom 1777 were males (53.1%). The percentages who had normal BMI, or were overweight, mildly obese and moderately obese+ were 18.9, 29.9, 25.1 and 26.1%, respectively. Using people with normal BMI as the reference group, and after adjusting for age, socio-economic status, CKD stage, primary renal diagnoses, comorbidities including cancer, diabetes, peripheral vascular disease (PVD), chronic lung disease, coronary artery disease (CAD), and all other cardiovascular disease (CVD), the hazard ratios (HRs, 95% CI) of males for death without RRT were 0.65 (0.45–0.92, p = 0.016), 0.60 (0.40–0.90, p = 0.013), and 0.77 (0.50–1.19, p = 0.239) for the overweight, mildly obese and moderately obese+. With the same adjustments the hazard ratios for death without RRT in females were 0.96 (0.62–1.50, p = 0.864), 0.94 (0.59–1.49, p = 0.792) and 0.96 (0.60–1.53, p = 0.865) respectively. In males, with normal BMI as the reference group, the adjusted HRs of starting RRT were 1.15 (0.71–1.86, p = 0.579), 0.99 (0.59–1.66, p = 0.970), and 0.95 (0.56–1.61, p = 0.858) for the overweight, mildly obese and moderately obese+ groups, respectively, and in females they were 0.88 (0.44–1.76, p = 0.727), 0.94 (0.47–1.88, p = 0.862) and 0.65 (0.33–1.29, p = 0.219) respectively. CONCLUSIONS: More than 80% of these CKD patients were overweight or obese. Higher BMI seemed to be a significant “protective” factor against death without RRT in males but there was not a significant relationship in females. Higher BMI was not a risk factor for predicting RRT in either male or female patients with CKD.