Association of Abdominal Adiposity with Cardiovascular Mortality in Incident Hemodialysis

Jessica Fitzpatrick, Stephen M. Sozio, Bernard G. Jaar, Mara A. McAdams-Demarco, Michelle M. Estrella, Larisa Tereshchenko, Jose M. Monroy-Trujillo, Rulan S. Parekh

    Research output: Contribution to journalArticle

    Abstract

    Background: The risk of cardiovascular mortality is high among adults with end-stage renal disease (ESRD) undergoing hemodialysis. Waist-to-hip ratio (WHR), a metric of abdominal adiposity, is a predictor of cardiovascular disease (CVD) and mortality in the general population; however, no studies have examined the association with CVD mortality, particularly sudden cardiac death (SCD), in incident hemodialysis. Methods: Among 379 participants incident (< 6 months) to hemodialysis enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in ESRD study, we evaluated associations between WHR and risk of CVD mortality, SCD, and non-CVD mortality in Cox proportional hazards regression models. Results: At study enrollment, mean age was 55 years with 41% females, 73% African Americans, and 57% diabetics. Mean body mass index was 29.3 kg/m2, and mean WHR was 0.95. During a median follow-up time of 2.5 years, there were 35 CVD deaths, 15 SCDs, and 48 non-CVD deaths. Every 0.1 increase in WHR was associated with higher risk (hazard ratio [95% CI]) of CVD mortality (1.75 [1.06-2.86]) and SCD (2.45 [1.20-5.02]), but not non-CVD mortality (0.93 [0.59-1.45]), independently of demographics, body mass index, comorbidities, inflammation, and traditional CVD risk factors. Conclusions: WHR is significantly associated with CVD mortality including SCD, independently of other CVD risk factors in incident hemodialysis. This simple, easily obtained bedside metric may be useful in dialysis patients for CVD risk stratification.

    Original languageEnglish (US)
    Pages (from-to)406-414
    Number of pages9
    JournalAmerican Journal of Nephrology
    DOIs
    StateAccepted/In press - Jan 1 2018

    Fingerprint

    Adiposity
    Renal Dialysis
    Cardiovascular Diseases
    Waist-Hip Ratio
    Mortality
    Sudden Cardiac Death
    Chronic Kidney Failure
    Body Mass Index
    Proportional Hazards Models
    African Americans
    Comorbidity
    Dialysis
    Heart Diseases
    Odds Ratio
    Demography
    Inflammation

    Keywords

    • Abdominal adiposity
    • End stage renal disease
    • Mortality
    • Sudden cardiac death
    • Waist-to-hip ratio

    ASJC Scopus subject areas

    • Nephrology

    Cite this

    Fitzpatrick, J., Sozio, S. M., Jaar, B. G., McAdams-Demarco, M. A., Estrella, M. M., Tereshchenko, L., ... Parekh, R. S. (Accepted/In press). Association of Abdominal Adiposity with Cardiovascular Mortality in Incident Hemodialysis. American Journal of Nephrology, 406-414. https://doi.org/10.1159/000494281

    Association of Abdominal Adiposity with Cardiovascular Mortality in Incident Hemodialysis. / Fitzpatrick, Jessica; Sozio, Stephen M.; Jaar, Bernard G.; McAdams-Demarco, Mara A.; Estrella, Michelle M.; Tereshchenko, Larisa; Monroy-Trujillo, Jose M.; Parekh, Rulan S.

    In: American Journal of Nephrology, 01.01.2018, p. 406-414.

    Research output: Contribution to journalArticle

    Fitzpatrick, J, Sozio, SM, Jaar, BG, McAdams-Demarco, MA, Estrella, MM, Tereshchenko, L, Monroy-Trujillo, JM & Parekh, RS 2018, 'Association of Abdominal Adiposity with Cardiovascular Mortality in Incident Hemodialysis', American Journal of Nephrology, pp. 406-414. https://doi.org/10.1159/000494281
    Fitzpatrick, Jessica ; Sozio, Stephen M. ; Jaar, Bernard G. ; McAdams-Demarco, Mara A. ; Estrella, Michelle M. ; Tereshchenko, Larisa ; Monroy-Trujillo, Jose M. ; Parekh, Rulan S. / Association of Abdominal Adiposity with Cardiovascular Mortality in Incident Hemodialysis. In: American Journal of Nephrology. 2018 ; pp. 406-414.
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    abstract = "Background: The risk of cardiovascular mortality is high among adults with end-stage renal disease (ESRD) undergoing hemodialysis. Waist-to-hip ratio (WHR), a metric of abdominal adiposity, is a predictor of cardiovascular disease (CVD) and mortality in the general population; however, no studies have examined the association with CVD mortality, particularly sudden cardiac death (SCD), in incident hemodialysis. Methods: Among 379 participants incident (< 6 months) to hemodialysis enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in ESRD study, we evaluated associations between WHR and risk of CVD mortality, SCD, and non-CVD mortality in Cox proportional hazards regression models. Results: At study enrollment, mean age was 55 years with 41{\%} females, 73{\%} African Americans, and 57{\%} diabetics. Mean body mass index was 29.3 kg/m2, and mean WHR was 0.95. During a median follow-up time of 2.5 years, there were 35 CVD deaths, 15 SCDs, and 48 non-CVD deaths. Every 0.1 increase in WHR was associated with higher risk (hazard ratio [95{\%} CI]) of CVD mortality (1.75 [1.06-2.86]) and SCD (2.45 [1.20-5.02]), but not non-CVD mortality (0.93 [0.59-1.45]), independently of demographics, body mass index, comorbidities, inflammation, and traditional CVD risk factors. Conclusions: WHR is significantly associated with CVD mortality including SCD, independently of other CVD risk factors in incident hemodialysis. This simple, easily obtained bedside metric may be useful in dialysis patients for CVD risk stratification.",
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    AU - Fitzpatrick, Jessica

    AU - Sozio, Stephen M.

    AU - Jaar, Bernard G.

    AU - McAdams-Demarco, Mara A.

    AU - Estrella, Michelle M.

    AU - Tereshchenko, Larisa

    AU - Monroy-Trujillo, Jose M.

    AU - Parekh, Rulan S.

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    N2 - Background: The risk of cardiovascular mortality is high among adults with end-stage renal disease (ESRD) undergoing hemodialysis. Waist-to-hip ratio (WHR), a metric of abdominal adiposity, is a predictor of cardiovascular disease (CVD) and mortality in the general population; however, no studies have examined the association with CVD mortality, particularly sudden cardiac death (SCD), in incident hemodialysis. Methods: Among 379 participants incident (< 6 months) to hemodialysis enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in ESRD study, we evaluated associations between WHR and risk of CVD mortality, SCD, and non-CVD mortality in Cox proportional hazards regression models. Results: At study enrollment, mean age was 55 years with 41% females, 73% African Americans, and 57% diabetics. Mean body mass index was 29.3 kg/m2, and mean WHR was 0.95. During a median follow-up time of 2.5 years, there were 35 CVD deaths, 15 SCDs, and 48 non-CVD deaths. Every 0.1 increase in WHR was associated with higher risk (hazard ratio [95% CI]) of CVD mortality (1.75 [1.06-2.86]) and SCD (2.45 [1.20-5.02]), but not non-CVD mortality (0.93 [0.59-1.45]), independently of demographics, body mass index, comorbidities, inflammation, and traditional CVD risk factors. Conclusions: WHR is significantly associated with CVD mortality including SCD, independently of other CVD risk factors in incident hemodialysis. This simple, easily obtained bedside metric may be useful in dialysis patients for CVD risk stratification.

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