BMI as an Indicator of Serum Albumin and its Role as a Prognostic Factor for Taiwanese Patients with ESRD on Hemodialysis

Size: px

Start display at page:

Download "BMI as an Indicator of Serum Albumin and its Role as a Prognostic Factor for Taiwanese Patients with ESRD on Hemodialysis"

Clementine Martha Montgomery
7 years ago
Views:

1 BMI as an Indicator of Serum Albumin and its Role as a Prognostic Factor for Taiwanese Patients with ESRD on Hemodialysis Anny Xiao, OMS II Yin-Cheng Chen, MD Athena Lin, MD Touro University College of Osteopathic Medicine Global Health Internship Program: Taiwan International Healthcare Training Center, Taipei, Taiwan

2 Background: Kidney Disease in Taiwan 2012 USRDS Annual Data Report

3 Background: Kidney Disease in Taiwan ESRD Prevalence: 2584 per million in 2010 Risk factors for CKD: Smoking, obesity, regular herbal medicine use, chronic lead exposure, hepatitis C, family history of ESRD Dialysis: 89.6% HD & 10.4% PD patients in 2010

4 Background: Kidney Disease in Taiwan Chinese herbal medicine use is independently associated with CKD in adults not using analgesics Consumption of Chinese herbs containing aristolochic acid shown to cause ESRD in Taiwan Aristolochic acid banned by Taiwan DOH in 2003 Herbal medicine perceived as less harmful than Western medicine

5 Background: BMI, Albumin, and ESRD BMI is predictive of mortality risk in ESRD patients Obesity paradox in hemodialysis patients: High BMI associated with lower all-cause mortality rates Indicator of nutritional status Hypoalbuminemia (< 3.5 g/dl) is an independent risk factor for morbidity and mortality Marker of inflammation and cardiac disease Possible explanations: Malnutrition and inflammation Protein-energy wasting

6 Background: BMI in Taiwanese population World Health Organization report: Asians have a higher percentage of body fat than Caucasians of the same age, sex, and BMI Chang et al study conclusions: Taiwanese subjects had a relatively lower BMI but a higher BF% than Caucasians Proposed adjusted overweight and obesity criteria in the Taiwanese population: Overweight: BMI 23 kg/m 2 Obesity: BMI 25 kg/m 2

7 Study Goals Determine the relationship between BMI and serum albumin in a cohort of Taiwanese patients by cross-sectional analysis Further elucidate the role of BMI as a prognostic factor based on its relationship to albumin Suggest an optimal BMI range for ESRD patients on hemodialysis in Taiwan

8 Hypothesis A body mass index > 25 kg/m 2 correlates with a higher serum albumin than a body mass index < 25 kg/m 2 in Taiwanese ESRD patients on hemodialysis

9 Study Population Taiwanese ESRD patients receiving hemodialysis 3 times per week at the TIHTC Taipei Hospital Hemodialysis Center. N = 131 Average age: 63.0 ± % male, 45% female Average length of dialysis treatment: 4.67 years

10 Methods Data collected: Age Height and post-hd dry weight BMI was obtained by body weight (kg) divided by squared body height (m 2 ) Serum albumin Used as a marker for mortality risk Number of other systemic diseases Date of maintenance hemodialysis initiation

11 Methods Comparison of serum albumin in: Patients with BMI < 25 kg/m 2 (N = 81) versus patients with BMI > 25 kg/m 2 (N = 50) Matched for average age, number of comorbidities, years of hemodialysis treatment, and sex Subgroups according to current international BMI classification Underweight BMI < 18.5 kg/m 2 (N = 81) Normal BMI kg/m 2 (N = 73) Overweight BMI kg/m 2 (N = 44) Obese BMI > 30 kg/m 2 (N = 6)

12 Results Serum albumin in patients with BMI < 25 kg/m 2 Average: 3.37 ± 0.35 g/dl Median: 3.4 g/dl Serum albumin in patients with BMI > 25 kg/m 2 Average: 3.50 ± 0.32 g/dl Median: 3.5 g/dl Serum albumin is higher in patients with BMI > 25 kg/m 2 (P = 0.019)

Number of patients Results 50 47 45 40 35 30 34 32 25 20 18 serum

13 Number of patients Results serum albumin <3.5 g/dl serum albumin >3.5 g/dl BMI <25 kg/m2 BMI >25 kg/m2

14 Average serum albumin (g/dl) Results Average serum albumin of BMI subgroups: 3.28 ± 0.44 g/dl for Underweight BMI < 18.5 kg/m ± 0.34 g/dl for Normal BMI kg/m ± 0.32 g/dl for Overweight BMI kg/m ± 0.26 g/dl for Obese BMI > 30 kg/m Overweight Normal Obese Underweight Average BMI (kg/m 2 )

15 BMI (kg/m2 ) Results 3.53 ± 0.32 g/dl for overweight BMI kg/m 2 Positive correlation of BMI and serum albumin R(42) = 0.4, p < Serum Albumin (g/dl)

16 Conclusions BMI in the overweight range ( kg/m 2 ) was positively correlated with serum albumin levels Patients in the overweight BMI group had the highest average serum albumin levels BMI may be a useful prognostic factor in Taiwanese ESRD patients Taiwanese ESRD patients on hemodialysis may benefit from achieving a goal BMI of kg/m 2

17 Implications Body weight management and optimizing dietary nutrient intake may help reduce high mortality rates in the Taiwanese hemodialysis population Expansion of Taiwan s nationwide CKD Preventive Project to include dietary counseling for ESRD patients on dialysis may improve prognosis Hemodialysis patients with BMI <25 kg/m 2 can be encouraged to eat more to replenish protein, energy and nutrients 多吃!

18 Acknowledgements Touro University California, College of Osteopathic Medicine Global Health Program Research Department Taiwan International Healthcare Training Center, Taipei Hospital, Taipei, Taiwan (ROC) Director Yin-Cheng Chen, MD, Taipei Hospital, Department of Nephrology Athena Lin, PhD, Touro University California, College of Osteopathic Medicine, Department of Basic Sciences

19 References United States Renal Data System 2012 Annual Data Report, International Comparisons Hwang, S.J., Tsai, J.C. and Chen, H.C. (2010), Epidemiology, impact and preventive care of chronic kidney disease in Taiwan. Nephrology, 2010;15: 3 9 Molnar MZ, Kalantar-Zadeh K. Body Composition and Outcomes in Dialysis Patients and Renal Transplant Recipients. Nephro-Urol Mon. 2011;3(3): Park J, Ahmadi SF, Streja E, Molnar MZ, Flegal KM, Gillen D, Kovesdy CP, Kalantar-Zadeh K. Obesity Paradox in end-stage kidney disease patients. Prog Cardiovasc Dis. 2014;56(4): Mafra D, Farage NE, Azevedo DL, Viana GG, Mattos JP, Velarde LG, Fouque D. Impact of serum albumin and body-mass index on survival in hemodialysis patients. Int Urol Nephrol. 2007;39(2): Foley RN, Parfrey PS, Harnett JD, Kent GM, Murray DC, Barre PE. Hypoalbuminemia, cardiac morbidity, and mortality in end-stage renal disease. J Am Soc Nephrol. 1996;7(5): World Health Organization Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363:157-63

Current Renal Replacement Therapy in Korea - Insan Memorial Dialysis Registry, 2011 - ESRD Registry Committee, Korean Society of Nephrology*

Current Renal Replacement Therapy in Korea - Insan Memorial Dialysis Registry, 2011 - ESRD Registry Committee, Korean Society of Nephrology* =Abstracts= Registry committee of Korean Society of Nephrology