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ASSOCIATION OF BODY MASS INDEX AND OUTCOME IN CHRONIC HEMODIALYSIS PATIENTS REQUIRING INTENSIVE CARE THERAPY
20 June 2017 (online)
In patients with end-stage renal disease (ESRD) a positive association of body mass index (BMI) and outcome, the “obesity paradox” has been described.
In a large group of intensive care patients we assessed whether a potential beneficial effect of a high body mass is also seen in ESRD patients with critical illness.
Setting, Design and Participants: In a retrospective analysis of a prospectively collected data base of 82,323 patients from 98 Austrian intensive care units (ICUs) in whom BMI was available, in 9,869 patients with ESRD the association of 6 groups of BMI and outcome was assessed. Results were adjusted for severity of disease, age, sex and other acute and chronic comorbidities.
The 9,869 patients with ESRD were older, sicker, had a longer ICU stay and a higher ICU and hospital mortality. Within the group of ESRD patients a high BMI (> 25) was associated with an improved survival in a multivariate analysis, but this was not seen in morbidly obese patients with a BMI > 40. The association was significant in patients with the highest disease severity (SAPS-3 Score > 56) but remarkably, also in those patients without systemic inflammatory response syndrome (SIRS) and those not requiring mechanical ventilation.
Also in ESRD patients who have acquired an acute intermittent diseases and are admitted to an ICU an increased BMI is associated with an improved outcome. This association however, is not seen in morbidly obese patients with a BMI > 40. This improved tolerance to acute disease processes may in part explain the “obesity paradox” observed in ESRD patients.
Disclosure of Interest: