Better Survival Rate for Over Weight Dialysis Patients

[Black]

http://www.ajcn.org/cgi/reprint/80/2/324.pdf

According to this study, during the first year of dialysis, patients with higher BMI have better survival rates.

[Zach]

Good report!  Dr. Evil mentioned it, but never gave us a link.
Thanks Black.       

In fact, larger wt people do better on dialysis, even with lower Kt/V....this holds true across all ages, even adjusting for other illnesses, etc.

[jbeany]

Okay, so if I'm reading this right. . .

There's no advantage to a high BMI for those starting PD.

There are higher survival rates for those with higher BMI's who start hemo, which they theorize is because hemo can cause wasting. (I notice they don't actually mention the crappy diet.)

There's no substantial proof that high BMI is a real problem during transplants.

But I'm supposed to have a BMI below 30 in order to get a transplant - that's a pretty universal standard.

But if I lose weight to qualify for the transplant list, I may be decreasing my survival rate on hemo while I'm waiting for the transplant.

Nice.  Anyone else's head spinning, now?

[kitkatz]

Mine's been spinning for eight years now!

[Sara]

Wow, there's actually something in Joe's favor. 

[Ohio Buckeye]

What, have I spent years trying to lose weight only
to shorten my lifespan.  Well, at least I still need to lose 10 or so lbs.
so not skinny yet.  Should have read that earlier.  ha
Funny how I thought losing weight would make me a healthier person but
it did not.

[BigSky]

But I'm supposed to have a BMI below 30 in order to get a transplant - that's a pretty universal standard.

But if I lose weight to qualify for the transplant list, I may be decreasing my survival rate on hemo while I'm waiting for the transplant.

Nice.  Anyone else's head spinning, now?

I think I am reading the chart right, however....

By the chart there does not seem to be any significant decrease in survival rate for women from the 28-31 BMI class to the BMI class of greater than 37.  (Chart A on page 328)  Using the the average height in the study of  roughly 5 feet 6 inches a BMI of 30 would be 50 pounds over ideal weight and a BMI of 37 would be 100 pounds over ideal weight in rough terms.

[jbeany]

Yes, apparently I'm supposed to lose a little weight, but not actually get down to what most docs would consider a healthy weight.  So if I manage to drop back down to what I was before I got sick, it would actually be bad for my survival rate.  It all just seems so counterintuitive, yes?

[Black]

The study was based on the first year of dialysis.  I suspect that the thin patients did not do as well because of all of the crappy days new patients have which interfere with their getting adequate nutrition and they had no body fat in reserve.  The overweight patients had some reserves and maybe were more food oriented, which helped them handle the bad times they encountered in the first year. JMO

[Zach]

The study was based on the first year of dialysis.  I suspect that the thin patients did not do as well because of all of the crappy days new patients have which interfere with their getting adequate nutrition and they had no body fat in reserve.  The overweight patients had some reserves and maybe were more food oriented, which helped them handle the bad times they encountered in the first year. JMO

Very good point, Black.     

[AlasdairUK]

This is just in the first year, this could be to the fact that people who are ill and under weight will be worse off than over weight people. I still feel that if you are at a healthy BMI it is better for the long run as we renal patients already face an issue with heart problems. The extra fat will just add to any problems. My  not based on any medical stats.

[Bajanne]

There is finally something positive about my weight!  But the thing is, that I began losing weight from the time I started haemodialysis, and I am now more than 25 lbs lighter than when I started a year ago.