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2008T Fresenius Hemodialysis

Interview with
Jeffrey H. Burbank
Founder& CEO of NxStage

Publication:

Obesity and Mortality Risk among Younger Dialysis Patients

Ellen K. Hoogeveen, Nynke Halbesma, Kenneth J. Rothman, Theo Stijnen, Sandra van Dijk, Friedo W. Dekker, Elisabeth W. Boeschoten, Renée de Mutsert for the Netherlands Cooperative Study on the Adequacy of Dialysis-2, 
(NECOSAD) Study, and Group
CJN.05700611; published ahead of print January 5, 2012,doi:10.2215/CJN.05700611

The study followed 1,749 dialysis patients until they had a transplant or died, or for a maximum of seven years. All patients were to begin dialysis when the study started.

This study investigated the extent to which the relation of body mass index (BMI) and mortality differs between younger and older dialysis patients.

 We found a higher risk of mortality for both the obesity (BMI ≥30 kg/m²) and underweight (BMI<20 kg/m²) dialysis patients younger than 65 years. 

Younger obese dialysis patients had a 70 percent greater risk of dying in seven years than young patients with a normal weight. The relation between obesity and mortality was even more pronounced among patients younger than 50 years: they had a more than twofold increased mortality rate.

There was no higher risk of death for obese patients over 65.

Our finding that obesity is a risk factor for mortality among younger dialysis patients is a paradigm shift.

Until recently it has been suggested that something called the "obesity paradox" protects obese dialysis patients.

The clinical implications of this study are as follows:

1. First, that potential kidney recipients younger than 65 years on dialysis treatment should be encouraged to lose weight if obese.

2. Second, for patients younger than 65 years, who are not eligible for kidney transplantation, identification of potential modifiable cardiovascular risk factors, such as obesity, is important to improve life expectancy.

Future research could focus on the most effective and healthy way to strive for normal weight among younger dialysis patients.