Document Detail

Body mass index-mortality paradox in hemodialysis: can it be explained by blood pressure?
MedLine Citation:
PMID:  22042814     Owner:  NLM     Status:  MEDLINE    
Unlike the general population, among hemodialysis patients body mass index (BMI) is related to blood pressure (BP) and mortality inversely. To explore the reasons for this risk-factor paradox, the cross-sectional association of obesity with the following factors was examined: the prevalence of hypertension, its control, and echocardiographic left ventricular mass index (LVMI). Longitudinal follow-up explored the relationship of BMI with all-cause mortality. Furthermore, it explored whether poorer survival in leaner individuals was related to either high BP or greater LVMI. Among 368 hemodialysis patients, both the prevalence of hypertension and its poor control were inversely related to BMI. BMI was also inversely associated with evidence of excess extracellular fluid volume, but adjustment for this variable did not completely remove the inverse relationship between BP and BMI. Over 1122 patient-years of cumulative follow-up (median: 2.7 years), 119 patients (32%) died. In the first 2 years of follow-up, the mortality hazard for the lowest BMI group was increased; thereafter, the survival curves were similar. Adjusting for several risk factors including BP and LVMI did not remove the inverse relationship of BMI with mortality. In conclusion, leaner patients on dialysis have a higher prevalence of hypertension, poorer control of hypertension, more LVMI, and greater evidence of extracellular fluid volume excess. However, volume explains the greater prevalence or poorer control of hypertension only partially. Leaner patients have an accelerated mortality rate in the first 2 years; this is not completely explained by BP, LVMI, or other cardiovascular or dialysis-specific risk factors.
Rajiv Agarwal
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, Non-P.H.S.     Date:  2011-10-31
Journal Detail:
Title:  Hypertension     Volume:  58     ISSN:  1524-4563     ISO Abbreviation:  Hypertension     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-11-18     Completed Date:  2012-01-03     Revised Date:  2014-09-14    
Medline Journal Info:
Nlm Unique ID:  7906255     Medline TA:  Hypertension     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1014-20     Citation Subset:  IM    
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MeSH Terms
Blood Pressure Monitoring, Ambulatory
Body Fluids
Body Mass Index*
Cross-Sectional Studies
Follow-Up Studies
Hypertension / epidemiology*
Hypertrophy, Left Ventricular / epidemiology,  ultrasonography
Kaplan-Meier Estimate
Kidney Failure, Chronic / epidemiology*,  therapy
Middle Aged
Obesity / epidemiology
Renal Dialysis*
Risk Factors
Thinness / epidemiology
Grant Support
2R01-NIDDK062030-07//PHS HHS; R01 DK062030/DK/NIDDK NIH HHS; R01 DK062030-08/DK/NIDDK NIH HHS
Comment In:
Hypertension. 2011 Dec;58(6):989-90   [PMID:  22042815 ]
Hypertension. 2012 Apr;59(4):e31; author reply e32   [PMID:  22353607 ]

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