Abstract
Background: In the general population with coronavirus disease 2019 (COVID-19), obesity is associated with an increased risk of mortality. Given the typically observed obesity paradox among patients on kidney function replacement therapy (KFRT), especially dialysis patients, we examined the association of obesity with mortality among dialysis patients or living with a kidney transplant with COVID-19. Methods: Data from the European Renal Association COVID-19 Database (ERACODA) were used. KFRT patients diagnosed with COVID-19 between 1 February 2020 and 31 January 2021 were included. The association of Quetelet's body mass index (BMI) (kg/m2), divided into: <18.5 (lean), 18.5-24.9 (normal weight), 25-29.9 (overweight), 30-34.9 (obese I) and ≥35 (obese II/III), with 3-month mortality was investigated using Cox proportional-hazards regression analyses. Results: In 3160 patients on KFRT (mean age: 65 years, male: 61%), 99 patients were lean, 1151 normal weight (reference), 1160 overweight, 525 obese I and 225 obese II/III. During follow-up of 3 months, 28, 20, 21, 23 and 27% of patients died in these categories, respectively. In the fully adjusted model, the hazard ratios (HRs) for 3-month mortality were 1.65 [95% confidence interval (CI): 1.10, 2.47], 1 (ref.), 1.07 (95% CI: 0.89, 1.28), 1.17 (95% CI: 0.93, 1.46) and 1.71 (95% CI: 1.27, 2.30), respectively. Results were similar among dialysis patients (N = 2343) and among those living with a kidney transplant (N = 817) (Pinteraction = 0.99), but differed by sex (Pinteraction = 0.019). In males, the HRs for the association of aforementioned BMI categories with 3-month mortality were 2.07 (95% CI: 1.22, 3.52), 1 (ref.), 0.97 (95% CI: 0.78. 1.21), 0.99 (95% CI: 0.74, 1.33) and 1.22 (95% CI: 0.78, 1.91), respectively, and in females corresponding HRs were 1.34 (95% CI: 0.70, 2.57), 1 (ref.), 1.31 (95% CI: 0.94, 1.85), 1.54 (95% CI: 1.05, 2.26) and 2.49 (95% CI: 1.62, 3.84), respectively. Conclusion: In KFRT patients with COVID-19, on dialysis or a kidney transplant, obesity is associated with an increased risk of mortality at 3 months. This is in contrast to the obesity paradox generally observed in dialysis patients. Additional studies are required to corroborate the sex difference in the association of obesity with mortality.
| Original language | English |
|---|---|
| Pages (from-to) | 1348-1360 |
| Number of pages | 13 |
| Journal | Clinical Kidney Journal |
| Volume | 15 |
| Issue number | 7 |
| DOIs | |
| Publication status | Published - 1 Jul 2022 |
Keywords
- COVID-19
- kidney failure
- mortality
- obesity paradox
- reverse epidemiology
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In: Clinical Kidney Journal, Vol. 15, No. 7, 01.07.2022, p. 1348-1360.
Research output: Contribution to journal › Article › Academic › peer-review
TY - JOUR
T1 - Association of obesity with 3-month mortality in kidney failure patients with COVID-19
AU - Tantisattamo, Ekamol
AU - Imhof, Celine
AU - Jager, Kitty J.
AU - Hilbrands, Luuk B.
AU - Guidotti, Rebecca
AU - Islam, Mahmud
AU - Katicic, Dajana
AU - Konings, Constantijn
AU - Molenaar, Femke M.
AU - Nistor, Ionut
AU - Noordzij, Marlies
AU - Rodríguez Ferrero, Mariá Luisa
AU - Verhoeven, Martine A. M.
AU - de Vries, Aiko P. J.
AU - Kalantar-Zadeh, Kamyar
AU - Gansevoort, Ron T.
AU - Vart, Priya
AU - van der Net, Jeroen B.
AU - Essig, Marie
AU - du Buf-Vereijken, Peggy W. G.
AU - van Ginneken, Betty
AU - Maas, Nanda
AU - van Jaarsveld, Brigit C.
AU - Bemelman, Frederike J.
AU - Klingenberg-Salahova, Farah
AU - Heenan-Vos, Frederiek
AU - Vervloet, Marc G.
AU - Nurmohamed, Azam
AU - Vogt, Liffert
AU - Abramowicz, Daniel
AU - Verhofstede, Sabine
AU - Maoujoud, Omar
AU - Malfait, Thomas
AU - Fialova, Jana
AU - Melilli, Edoardo
AU - Favà, Alexandre
AU - Cruzado, Josep M.
AU - Perez, Nuria Montero
AU - Lips, Joy
AU - Krepel, Harmen
AU - Adilovic, Harun
AU - Radulescu, Daniela
AU - Hengst, Maaike
AU - Rydzewski, Andrzej
AU - Braconnier, Philippe
AU - Weis, Daniel
AU - Gellert, Ryszard
AU - Oliveira, Joaõ
AU - Alferes, Daniela G.
AU - Zakharova, Elena V.
AU - Ambuehl, Patrice Max
AU - Walker, Andrea
AU - Lepeytre, Fanny
AU - Rabate, Clementine
AU - Rostoker, Guy
AU - Marques, Sofia
AU - Azasevac, Tijana
AU - Majstorovic, Gordana Strazmester
AU - ten Dam, Marc
AU - Krüger, Thilo
AU - Brzosko, Szymon
AU - Liakopoulos, Vassilios
AU - Zanen, Adriaan L.
AU - Logtenberg, Susan J. J.
AU - Fricke, Lutz
AU - Kuryata, Olexandr
AU - Slebe, Jeroen J. P.
AU - Elhafeez, Samar Abd
AU - Kemlin, Delphine
AU - van de Wetering, Jacqueline
AU - Reinders, Marlies E. J.
AU - Hesselink, Dennis A.
AU - Kal-van Gestel, J.
AU - Eiselt, Jaromir
AU - Kielberger, Lukas
AU - el-Wakil, Hala S.
AU - Logan, Ian
AU - Canal, Cristina
AU - Facundo, Carme
AU - Ramos, Ana M.
AU - Debska-Slizien, Alicja
AU - Veldhuizen, Nicoline M. H.
AU - Tigka, Eirini
AU - Konsta, Maria Anna Polyzou
AU - Panagoutsos, Stylianos
AU - Mallamaci, Francesca
AU - Postorino, Adele
AU - Cambareri, Francesco
AU - Matceac, Irina
AU - Covic, Adrian
AU - Groeneveld, J. H. M.
AU - Jousma, Jolanda
AU - van Buren, Marjolijn
AU - Diekmann, Fritz
AU - Oppenheimer, Federico
AU - Blasco, Miquel
AU - Pereira, Tiago Assis
AU - Santos, Augusto Cesar S.
AU - Arias-Cabrales, Carlos
AU - Crespo, Marta
AU - Llinàs-Mallol, Laura
AU - Buxeda, Anna
AU - Tàrrega, Carla Burballa
AU - Redondo-Pachon, Dolores
AU - Jimenez, Maria Dolores Arenas
AU - Mendoza-Valderrey, Alberto
AU - Martins, Ana Cristina
AU - Mateus, Catarina
AU - Alvila, Goncalo
AU - Laranjinha, Ivo
AU - Hofstra, Julia M.
AU - Siezenga, Machiel A.
AU - Franco, Antonio
AU - Arroyo, David
AU - Castellano, Sandra
AU - Manzanos, Sagrario Balda
AU - Haridian Sosa Barrios, R.
AU - Lemahieu, Wim
AU - Bartelet, Karlijn
AU - Dirim, Ahmet Burak
AU - Demir, Erol
AU - Sever, Mehmet Sukru
AU - Turkmen, Aydin
AU - Safak, Seda
AU - Hollander, Daan A. M. J.
AU - Büttner, Stefan
AU - Meziyerh, Soufian
AU - van der Helm, Danny
AU - Mallat, Marko
AU - Bouwsma, Hanneke
AU - Sridharan, Sivakumar
AU - Petruliene, Kristina
AU - Maloney, Sharon-Rose
AU - Verberk, Iris
AU - van der Sande, Frank M.
AU - Christiaans, Maarten H. L.
AU - Hemmelder, Marc H.
AU - Kumar, Mohan N.
AU - di Luca, Marina
AU - Tuǧlular, Serhan Z.
AU - Ziekenhuis, Martini
AU - Kramer, Andrea B.
AU - Beerenhout, Charles
AU - Luik, Peter T.
AU - Kerschbaum, Julia
AU - Tiefenthaler, Martin
AU - Watschinger, Bruno
AU - Adema, Aaltje Y.
AU - Stepanov, Vadim A.
AU - Zulkarnaev, Alexey B.
AU - Turkmen, Kultigin
AU - Gandolfini, Ilaria
AU - Maggiore, Umberto
AU - Fliedner, Anselm
AU - Åsberg, Anders
AU - Mjoen, Geir
AU - Miyasato, Hitoshi
AU - de Fijter, Carola W. H.
AU - Mongera, Nicola
AU - Pini, Stefano
AU - de Biase, Consuelo
AU - Kerckhoffs, Angele
AU - Els van de Logt, Anne
AU - Maas, Rutger
AU - Duivenvoorden, Raphaël
AU - Lebedeva, Olga
AU - Lopez, Veronica
AU - Reichert, Louis J. M.
AU - Verhave, Jacobien
AU - Titov, Denis
AU - Parshina, Ekaterina V.
AU - Zanoli, Luca
AU - Marcantoni, Carmelita
AU - van Kempen, Gijs
AU - van Gils-Verrij, Liesbeth E. A.
AU - Harty, John C.
AU - Meurs, Marleen
AU - Myslak, Marek
AU - Battaglia, Yuri
AU - Lentini, Paolo
AU - den Deurwaarder, Edwin
AU - Stendahl, Maria
AU - Rahimzadeh, Hormat
AU - Schouten, Marcel
AU - Rychlik, Ivan
AU - Cabezas-Reina, Carlos J.
AU - Roca, Ana Maria
AU - Nauta, Ferdau
AU - Sahin, Idris
AU - Goffin, Eric
AU - Kanaan, Nada
AU - Labriola, Laura
AU - Devresse, Arnaud
AU - Diaz-Mareque, Anabel
AU - Coca, Armando
AU - de Arriba, Gabriel
AU - Meijers, Björn K. I.
AU - Naesens, Maarten
AU - Kuypers, Dirk
AU - Desschans, Bruno
AU - Tonnerlier, Annelies
AU - Wissing, Karl M.
AU - Dedinska, Ivana
AU - Pessolano, Giuseppina
AU - Malik, Shafi
AU - Dounousi, Evangelia
AU - Papachristou, Evangelos
AU - Berger, Stefan P.
AU - Meijer, Esther
AU - Sanders, Jan Stephan F.
AU - Franssen, Casper F. M.
AU - Özyilmaz, Akin
AU - Ponikvar, Jadranka Buturović
AU - Pernat, Andreja Marn
AU - Kovac, Damjan
AU - Arnol, Miha
AU - Ekart, Robert
AU - Abrahams, Alferso C.
AU - van Zuilen, Arjan D.
AU - Meijvis, Sabine C. A.
AU - Dolmans, Helma
AU - Esposito, Pasquale
AU - Krzesinski, Jean-Marie
AU - Barahira, Jean Damacène
AU - Gallieni, Maurizio
AU - Martin-Moreno, Paloma Leticia
AU - Guglielmetti, Gabriele
AU - Guzzo, Gabriella
AU - Toapanta, Nestor
AU - Soler, Maria Jose
AU - Luik, Antinus J.
AU - van Kuijk, Willi H. M.
AU - Stikkelbroeck, Lonneke W. H.
AU - Hermans, Marc M. H.
AU - Rimsevicius, Laurynas
AU - Righetti, Marco
AU - Heitink-ter Braak, Nicole
N1 - Publisher Copyright: © 2022 The Author(s). Published by Oxford University Press on behalf of the ERA.
PY - 2022/7/1
Y1 - 2022/7/1
N2 - Background: In the general population with coronavirus disease 2019 (COVID-19), obesity is associated with an increased risk of mortality. Given the typically observed obesity paradox among patients on kidney function replacement therapy (KFRT), especially dialysis patients, we examined the association of obesity with mortality among dialysis patients or living with a kidney transplant with COVID-19. Methods: Data from the European Renal Association COVID-19 Database (ERACODA) were used. KFRT patients diagnosed with COVID-19 between 1 February 2020 and 31 January 2021 were included. The association of Quetelet's body mass index (BMI) (kg/m2), divided into: <18.5 (lean), 18.5-24.9 (normal weight), 25-29.9 (overweight), 30-34.9 (obese I) and ≥35 (obese II/III), with 3-month mortality was investigated using Cox proportional-hazards regression analyses. Results: In 3160 patients on KFRT (mean age: 65 years, male: 61%), 99 patients were lean, 1151 normal weight (reference), 1160 overweight, 525 obese I and 225 obese II/III. During follow-up of 3 months, 28, 20, 21, 23 and 27% of patients died in these categories, respectively. In the fully adjusted model, the hazard ratios (HRs) for 3-month mortality were 1.65 [95% confidence interval (CI): 1.10, 2.47], 1 (ref.), 1.07 (95% CI: 0.89, 1.28), 1.17 (95% CI: 0.93, 1.46) and 1.71 (95% CI: 1.27, 2.30), respectively. Results were similar among dialysis patients (N = 2343) and among those living with a kidney transplant (N = 817) (Pinteraction = 0.99), but differed by sex (Pinteraction = 0.019). In males, the HRs for the association of aforementioned BMI categories with 3-month mortality were 2.07 (95% CI: 1.22, 3.52), 1 (ref.), 0.97 (95% CI: 0.78. 1.21), 0.99 (95% CI: 0.74, 1.33) and 1.22 (95% CI: 0.78, 1.91), respectively, and in females corresponding HRs were 1.34 (95% CI: 0.70, 2.57), 1 (ref.), 1.31 (95% CI: 0.94, 1.85), 1.54 (95% CI: 1.05, 2.26) and 2.49 (95% CI: 1.62, 3.84), respectively. Conclusion: In KFRT patients with COVID-19, on dialysis or a kidney transplant, obesity is associated with an increased risk of mortality at 3 months. This is in contrast to the obesity paradox generally observed in dialysis patients. Additional studies are required to corroborate the sex difference in the association of obesity with mortality.
AB - Background: In the general population with coronavirus disease 2019 (COVID-19), obesity is associated with an increased risk of mortality. Given the typically observed obesity paradox among patients on kidney function replacement therapy (KFRT), especially dialysis patients, we examined the association of obesity with mortality among dialysis patients or living with a kidney transplant with COVID-19. Methods: Data from the European Renal Association COVID-19 Database (ERACODA) were used. KFRT patients diagnosed with COVID-19 between 1 February 2020 and 31 January 2021 were included. The association of Quetelet's body mass index (BMI) (kg/m2), divided into: <18.5 (lean), 18.5-24.9 (normal weight), 25-29.9 (overweight), 30-34.9 (obese I) and ≥35 (obese II/III), with 3-month mortality was investigated using Cox proportional-hazards regression analyses. Results: In 3160 patients on KFRT (mean age: 65 years, male: 61%), 99 patients were lean, 1151 normal weight (reference), 1160 overweight, 525 obese I and 225 obese II/III. During follow-up of 3 months, 28, 20, 21, 23 and 27% of patients died in these categories, respectively. In the fully adjusted model, the hazard ratios (HRs) for 3-month mortality were 1.65 [95% confidence interval (CI): 1.10, 2.47], 1 (ref.), 1.07 (95% CI: 0.89, 1.28), 1.17 (95% CI: 0.93, 1.46) and 1.71 (95% CI: 1.27, 2.30), respectively. Results were similar among dialysis patients (N = 2343) and among those living with a kidney transplant (N = 817) (Pinteraction = 0.99), but differed by sex (Pinteraction = 0.019). In males, the HRs for the association of aforementioned BMI categories with 3-month mortality were 2.07 (95% CI: 1.22, 3.52), 1 (ref.), 0.97 (95% CI: 0.78. 1.21), 0.99 (95% CI: 0.74, 1.33) and 1.22 (95% CI: 0.78, 1.91), respectively, and in females corresponding HRs were 1.34 (95% CI: 0.70, 2.57), 1 (ref.), 1.31 (95% CI: 0.94, 1.85), 1.54 (95% CI: 1.05, 2.26) and 2.49 (95% CI: 1.62, 3.84), respectively. Conclusion: In KFRT patients with COVID-19, on dialysis or a kidney transplant, obesity is associated with an increased risk of mortality at 3 months. This is in contrast to the obesity paradox generally observed in dialysis patients. Additional studies are required to corroborate the sex difference in the association of obesity with mortality.
KW - COVID-19
KW - kidney failure
KW - mortality
KW - obesity paradox
KW - reverse epidemiology
UR - http://www.scopus.com/inward/record.url?scp=85142628371&partnerID=8YFLogxK
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85142628371&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/35747092
U2 - https://doi.org/10.1093/ckj/sfac083
DO - https://doi.org/10.1093/ckj/sfac083
M3 - Article
C2 - 35747092
SN - 2048-8505
VL - 15
SP - 1348
EP - 1360
JO - Clinical Kidney Journal
JF - Clinical Kidney Journal
IS - 7
ER -