Body mass index is inversely associated with mortality in patients with acute kidney injury undergoing continuous renal replacement therapy

Abstract

Background: Many epidemiologic studies have reported on the controversial concept of the obesity paradox. The presence of acute kidney injury (AKI) can accelerate energy-consuming processes, particularly in patients requiring continuous renal replacement therapy (CRRT). Thus, we aimed to investigate whether obesity can provide a survival benefit in this highly catabolic condition.

Methods: We conducted an observational study in 212 patients who had undergone CRRT owing to various causes of AKI between 2010 and 2014. The study end point was defined as death that occurred within 30 days after the initiation of CRRT.

Results: Patients were categorized into three groups according to tertiles of body mass index (BMI). During ≥30 days after the initiation of CRRT, 39 patients (57.4%) in the highest tertile died, as compared with 58 patients (78.4%) in the lowest tertile (P = 0.02). In a multivariable analysis adjusted for cofounding factors, the highest tertile of BMI was significantly associated with a decreased risk of death (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.37-0.87; P = 0.01). This significant association remained unaltered for 60-day (HR, 0.64; 95% CI, 0.43-0.94; P = 0.03) and 90-day mortality (HR, 0.66; 95% CI, 0.44-0.97; P = 0.03).

Conclusion: This study showed that a higher BMI confer a survival benefit over a lower BMI in AKI patients undergoing CRRT.

Keywords: Acute kidney injury; Body mass index; Continuous renal replacement therapy; Mortality; Obesity.

Figure 1. Flowchart of participants in the cohort

AKI, acute kidney injury; BMI, body mass index; ESRD, end stage renal disease.

Figure 2. Kaplan-Meier curves of the 30-day mortality according to body mass index tertiles

Figure 3. Hazard ratio for mortality according to presence of sepsis and cancer in fully adjusted model