Original investigationDialysis therapyAssociation of Morbid Obesity and Weight Change Over Time With Cardiovascular Survival in Hemodialysis Population
Section snippets
Database Creation
Database creation has been described elsewhere.7 In summary, the data warehouse of DaVita, Inc, the then second largest dialysis care provider in the United States, had information on approximately 40,000 patients at any given time and was accessed to obtain all relevant data between July 1, 2001, and June 30, 2003. All repeated measures of every relevant variable for each patient within a given quarter (13-week interval) were averaged to obtain 1 quarterly mean value for that variable. Hence,
Results
The original 2-year national database for all MHD patients included 69,819 subjects. After implementing the mentioned selection criteria, including deleting patients who were not maintained beyond 3 months of MHD therapy or who had inadequate or overtly missing data, the resulting cohort included 58,058 MHD patients, of whom 37,049 patients (64%) originated from the q1 data set, and the rest, from the subsequent quarters (q2 through q8). Table 1 lists baseline demographic, clinical, and
Discussion
In a national database cohort that included all eligible MHD patients of a major dialysis care provider with uniform patient management practices and standardized laboratory values, all measured in 1 laboratory, we found that obesity, including morbid obesity, is associated with improved survival and reduced cardiovascular death. These associations were independent of changes in BMI during the 2-year study period and held even after adjustment for time-varying laboratory surrogates of
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Cited by (0)
Originally published online as doi:10.1053/j.ajkd.2005.05.020 on July 15, 2005.
Supported in part by a Young Investigator Award from the National Kidney Foundation and grant no. DK61162 (K.K.-Z.) from the National Institute of Diabetes, and Digestive and Kidney Diseases. C.J.M. is an employee of DaVita, Inc.
- 1
K.K.-Z. contributed to the design of the study, collation and analysis of data, and writing of the manuscript and its revisions
- 2
J.D.K. contributed to the design and analysis of the study and provided advice and consultation on the writing of the manuscript and final review and approval
- 3
R.D.K. contributed to analysis of the data and reviewed and approved the final manuscript
- 4
C.J.M. contributed to the design of the study, provision of data, and final review and approval of the manuscript
- 5
C.S.S. contributed to analysis of the data and reviewed and approved the final manuscript
- 6
D.W.G. contributed to the design of the study and analysis of data and reviewed and approved the final manuscript
- 7
S.G. contributed to the design of the study, provided advice and consultation on the study design, analysis, and writing of the manuscript, and final review and approval