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American Journal of Kidney Diseases

Body size, dose of hemodialysis, and mortality

  • Robert A. Wolfe
    Affiliations
    US Renal Data System Coordinating Center, University of Michigan, Ann Arbor, MI; Westside Veterans Administration Hospital, University of Chicago, Chicago, IL; and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD.
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  • Valarie B. Ashby
    Affiliations
    US Renal Data System Coordinating Center, University of Michigan, Ann Arbor, MI; Westside Veterans Administration Hospital, University of Chicago, Chicago, IL; and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD.
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  • John T. Daugirdas
    Affiliations
    US Renal Data System Coordinating Center, University of Michigan, Ann Arbor, MI; Westside Veterans Administration Hospital, University of Chicago, Chicago, IL; and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD.
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  • Lawrence Y.C. Agodoa
    Affiliations
    US Renal Data System Coordinating Center, University of Michigan, Ann Arbor, MI; Westside Veterans Administration Hospital, University of Chicago, Chicago, IL; and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD.
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  • Camille A. Jones
    Affiliations
    US Renal Data System Coordinating Center, University of Michigan, Ann Arbor, MI; Westside Veterans Administration Hospital, University of Chicago, Chicago, IL; and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD.
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  • Friedrich K. Port
    Affiliations
    US Renal Data System Coordinating Center, University of Michigan, Ann Arbor, MI; Westside Veterans Administration Hospital, University of Chicago, Chicago, IL; and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD.
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      Abstract

      This study investigates the role of body size on the mortality risk associated with dialysis dose in chronic hemodialysis patients. A national US random sample from the US Renal Data System was used for this observational longitudinal study of 2-year mortality. Prevalent hemodialysis patients treated between 1990 and 1995 were included (n = 9,165). A Cox proportional hazards model, adjusting for patient characteristics, was used to calculate the relative risk (RR) for mortality. Both dialysis dose (equilibrated Kt/V [eKt/V]) and body size (body weight, body volume, and body mass index) were independently and significantly (P < 0.01 for each measure) inversely related to mortality when adjusted for age and diabetes. Mortality was less among larger patients and those receiving greater eKt/V. The overall association of mortality risk with eKt/V was negative and significant in all patient subgroups defined by body size and by race-sex categories in the range 0.6 < eKt/V < 1.6. The association was negative in the restricted range 0.9 < eKt/V < 1.6 (although not generally significant) for all body-size subgroups and for three of four race-by-sex subgroups, excepting black men (RR = 1.003/0.1 eKt/V; P > 0.95). These findings suggest that dose of dialysis and several measures of body size are important and independent correlates of mortality. These results suggest that patient management protocols should attempt to ensure both good patient nutrition and adequate dose of dialysis, in addition to managing coexisting medical conditions.

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