Pre-Dialysis Weight Loss in the Elderly Signals Higher Death Risk

Changes in body weight in advance of dialysis initiation are associated with significantly increased one-year mortality among nursing home residents, according to a new study.

The study, published in the Clinical Journal of the American Society of Nephrology (2013;8:1734-1740), included 11,090 nursing home residents who started dialysis from January 2000 to December 2006. Over one year of follow-up, 6,063 subjects (54.7%) died.

The researchers, led by Manjula Kurella Tamura, MD, of the Veterans Affairs Palo Alto Health Care System in Palo Alto, Calif., categorized patients according to their weight measured between three to six months  before dialysis initiation and the percentage change in body weight before dialysis initiation (divided into quintiles).

Patients with a weight loss of 15% or more (quintile 1) had a 35% higher risk of death within one year of starting dialysis compared with those who had minimal weight changes, defined as a 3% weight loss to a 3% weight gain (quintile 4), after adjusting for baseline body mass index (BMI) and other confounders. Patients with a weight gain of 4% or more (quintile 5) had a 24% higher risk of death.

Of the 11,090 patients, 361 (3.3%0 were underweight (BMI less than 18.5 kg/m2), 4,046 (36.5%) were obese (BMI 30 or higher) before dialysis initiation. Prior to dialysis initiation, the cohort had a median 6% decrease in body weight.

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