Obese trauma patients have increased need for dialysis

doi:10.1007/s00068-019-01147-9

. 2020 Dec;46(6):1327-1334.

doi: 10.1007/s00068-019-01147-9. Epub 2019 May 20.

Obese trauma patients have increased need for dialysis

Ahmed Farhat¹, Areg Grigorian², Ninh T Nguyen², Brian Smith², Barbara J Williams², Sebastian D Schubl², Victor Joe², Dawn Elfenbein², Jeffry Nahmias²

Affiliations

¹ Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA. amfarhat@uci.edu.
² Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA.

PMID: 31111163
DOI: 10.1007/s00068-019-01147-9

Obese trauma patients have increased need for dialysis

Ahmed Farhat et al. Eur J Trauma Emerg Surg. 2020 Dec.

. 2020 Dec;46(6):1327-1334.

doi: 10.1007/s00068-019-01147-9. Epub 2019 May 20.

Authors

Ahmed Farhat¹, Areg Grigorian², Ninh T Nguyen², Brian Smith², Barbara J Williams², Sebastian D Schubl², Victor Joe², Dawn Elfenbein², Jeffry Nahmias²

Affiliations

¹ Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA. amfarhat@uci.edu.
² Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA.

PMID: 31111163
DOI: 10.1007/s00068-019-01147-9

Abstract

Purpose: Obesity is a risk factor for the development of acute kidney injury but its effect on the need for dialysis in trauma has not been elucidated. Additionally, the contribution that obesity has towards risk of mortality in trauma is unclear. We hypothesized that patients with a higher body mass index (BMI) will have a higher risk for need of dialysis and mortality after trauma.

Methods: This is a retrospective analysis using the National Trauma Data Bank. All patients ≥ 8 years old were grouped based on BMI: normal (18.5-24.99 kg/m²), obese (30-34.99 kg/m²), severely obese (35-39.99 kg/m²) and morbidly obese (≥ 40 kg/m²). The primary outcome was hemodialysis initiation. The secondary outcome was mortality during the index hospitalization.

Results: From 988,988 trauma patients, 571,507 (57.8%) had a normal BMI, 233,340 (23.6%) were obese, 94,708 (9.6%) were severely obese, and 89,433 (9.0%) were morbidly obese. The overall rate of hemodialysis was 0.3%. After adjusting for covariates, we found that obese (OR 1.36, CI 1.22-1.52, p < 0.001), severely obese (OR 1.89, CI 1.66-2.15, p < 0.001) and morbidly obese (OR 2.04, CI 1.82-2.29, p < 0.001) patients had a stepwise increased need for hemodialysis after trauma. Obese patients had decreased (OR 0.92, CI 0.88-0.95, p < 0.001), severely obese had similar (OR 1.02, CI 0.97-1.08, p = 0.50) and morbidly obese patients had increased (OR 1.06, CI 1.01-1.12, p = 0.011) risk of mortality after trauma.

Conclusions: Obesity was associated with an increased risk for dialysis after trauma. Mortality risk was reduced in obese, similar in severely obese, and increased in morbidly obese trauma patients suggesting an inflection threshold BMI for risk of mortality in trauma.

Keywords: Acute kidney injury; Dialysis; Obesity; Renal replacement therapy; Trauma.

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References

1. Hales CM, Carroll MD, Fryar CD, et al. Prevalence of obesity among adults and youth: United States, 2015–2016. NCHS Data Brief. 2017;288:1–8.
1. Wang Y, Beydoin MA, Liang L, et al. Will all Americans become overweight or obese? Estimating the progression and cost of the US obesity epidemic. Obesity. 2008;16(10):2323–30 (Silver Spring). - PubMed
1. Neville AL, Brown CV, Weng J, et al. Obesity is an independent risk factor of mortality in severely injured blunt trauma patients. Arch Surg. 2004;139(9):983–7. - PubMed
1. Byrnes MC, McDaniel MD, Moore MB, et al. The effect of obesity on outcomes among injured patients. J Trauma. 2005;58(2):232–7. - PubMed
1. Alban RF, Lyass S, Margulies DR, et al. Obesity does not affect mortality after trauma. Am Surg. 2006;72(10):966–9. - PubMed

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[1] Hales CM, Carroll MD, Fryar CD, et al. Prevalence of obesity among adults and youth: United States, 2015–2016. NCHS Data Brief. 2017;288:1–8.

[2] Hales CM, Carroll MD, Fryar CD, et al. Prevalence of obesity among adults and youth: United States, 2015–2016. NCHS Data Brief. 2017;288:1–8.

[3] Wang Y, Beydoin MA, Liang L, et al. Will all Americans become overweight or obese? Estimating the progression and cost of the US obesity epidemic. Obesity. 2008;16(10):2323–30 (Silver Spring). - PubMed

[4] Wang Y, Beydoin MA, Liang L, et al. Will all Americans become overweight or obese? Estimating the progression and cost of the US obesity epidemic. Obesity. 2008;16(10):2323–30 (Silver Spring). - PubMed

[5] Neville AL, Brown CV, Weng J, et al. Obesity is an independent risk factor of mortality in severely injured blunt trauma patients. Arch Surg. 2004;139(9):983–7. - PubMed

[6] Neville AL, Brown CV, Weng J, et al. Obesity is an independent risk factor of mortality in severely injured blunt trauma patients. Arch Surg. 2004;139(9):983–7. - PubMed

[7] Byrnes MC, McDaniel MD, Moore MB, et al. The effect of obesity on outcomes among injured patients. J Trauma. 2005;58(2):232–7. - PubMed

[8] Byrnes MC, McDaniel MD, Moore MB, et al. The effect of obesity on outcomes among injured patients. J Trauma. 2005;58(2):232–7. - PubMed

[9] Alban RF, Lyass S, Margulies DR, et al. Obesity does not affect mortality after trauma. Am Surg. 2006;72(10):966–9. - PubMed

[10] Alban RF, Lyass S, Margulies DR, et al. Obesity does not affect mortality after trauma. Am Surg. 2006;72(10):966–9. - PubMed

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Obese trauma patients have increased need for dialysis

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Obese trauma patients have increased need for dialysis

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