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https://hdl.handle.net/2440/111836
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Type: | Journal article |
Title: | Obesity and the risk of cardiovascular and all-cause mortality in chronic kidney disease: a systematic review and meta-analysis |
Author: | Ladhani, M. Craig, J. Irving, M. Clayton, P. Wong, G. |
Citation: | Nephrology Dialysis Transplantation, 2017; 32(3):439-449 |
Publisher: | Oxford University Press |
Issue Date: | 2017 |
ISSN: | 0931-0509 1460-2385 |
Statement of Responsibility: | Maleeka Ladhani, Jonathan C. Craig, Michelle Irving, Philip A. Clayton and Germaine Wong |
Abstract: | Background: Obesity is a risk factor for cardiovascular disease and death in people without chronic kidney disease (CKD), but the effect of obesity in people with CKD is uncertain. Methods: Medline and Embase (from inception to January 2015) were searched for cohort studies measuring obesity by body mass index (BMI), waist:hip ratio (WHR) and/or waist circumference (WC) and all-cause and cardiovascular mortality or events in patients with any stage of CKD. Data were summarized using random effects models. Meta-regression was conducted to assess sources of heterogeneity. Results: Of 4065 potentially eligible citations, 165 studies ( n = 1 534 845 participants) were analyzed. In studies that found a nonlinear relationship, underweight people with CKD (3-5) on hemodialysis experienced an increased risk of death compared with those with normal weight. In transplant recipients, excess risk was observed at levels of morbid obesity (>35 kg/m 2 ). Of studies that found the relationship to be linear, a 1 kg/m 2 increase in BMI was associated with a 3 and 4% reduction in all-cause and cardiovascular mortality in patients on hemodialysis, respectively {adjusted hazard ratio [HR] 0.97 [95% confidence interval (CI) 0.96-0.98] and adjusted HR 0.96 (95% CI 0.92-1.00)}. In CKD Stages 3-5, for every 1 kg/m 2 increase in BMI there was a 1% reduction in all-cause mortality [HR 0.99 (95% CI 0.0.97-1.00)]. There was no apparent association between obesity and mortality in transplanted patients or those on peritoneal dialysis. Sparse data for WHR and WC did not allow further analyses. Conclusions: Being obese may be protective for all-cause mortality in the predialysis and hemodialysis populations, while being underweight suggests increased risk, but not in transplant recipients. |
Keywords: | Cardiovascular mortality; chronic kidney disease; meta-analysis; mortality; obesity; systematic review |
Rights: | © The Author 2016. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. |
DOI: | 10.1093/ndt/gfw075 |
Grant ID: | http://purl.org/au-research/grants/nhmrc/1074409 |
Published version: | http://dx.doi.org/10.1093/ndt/gfw075 |
Appears in Collections: | Aurora harvest 3 Medicine publications |
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