ArticleNephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association2016
Examining the robustness of the obesity paradox in maintenance hemodialysis patients: a marginal structural model analysis.
Article in Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 41 papers, 1 of them a synthesis that pooled it.
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Who cites it
41 citing papers in PubMed, 1 synthesis or guideline pooled it, 78 citations in OpenAlex.
- Obesity measurement methods estimated mortality risk in patients undergoing hemodialysis: a systematic review and meta-analysis.International urology and nephrology · 2025Pooled it
- Development and Validation of a Nomogram Model for Predicting the Risk of Readmission in Patients with Heart Failure with Reduced Ejection Fraction within 1 Year.Cardiovascular therapeutics · 2022Trial
- The Association of Social Determinants of Health on Mortality among Adults with End-Stage Kidney Disease: a Systematic Review and Meta-Analysis.Journal of racial and ethnic health disparities · 2026Review
- Long-term dynamic effect of body mass index on adverse cardiovascular outcomes with targeted maximum likelihood estimation method: result from the KNOW-CKD study.Scientific reports · 2026Article
- The Obesity Paradox Reconsidered: Evidence from a Multicenter Romanian Hemodialysis Cohort.Journal of clinical medicine · 2026Article
- Patient and clinician perspectives on the management of obesity in kidney failure prior to kidney transplantation: a mixed-methods systematic review.EClinicalMedicine · 2026Article
- Characteristics and prognostic values of abdominal aortic branches calcification in hemodialysis patients.Renal failure · 2025Article
- The association between body mass index and mortality in diabetic patients with end-stage renal disease is different in hemodialysis and peritoneal dialysis.Renal failure · 2025Article
- Association of systolic blood pressure with incident chronic kidney disease estimated by marginal structural model: a nationwide population-based study.Kidney research and clinical practice · 2025Article
- Nationwide mortality following acute type B aortic dissection and the survival advantage of obesity among dialysis patients in Japan.Journal of nephrology · 2025Article
- Hypertension and Cardiovascular Risk Among Children with Chronic Kidney Disease.Current hypertension reports · 2024Review
- Physical Activity, Cardiorespiratory Fitness, and the Obesity Paradox with Consideration for Racial and/or Ethnic Differences: A Broad Review and Call to Action.Reviews in cardiovascular medicine · 2024Review
- Patient and Health Care Professional Perspectives on Addressing Obesity in ESKD.American journal of kidney diseases : the official journal of the National Kidney Foundation · 2023Article
- Obesity Weight Loss Phenotypes in CKD: Findings From the Chronic Renal Insufficiency Cohort Study.Kidney international reports · 2023Article
- Dissecting the Obesity Paradox in Patients With Obesity and CKD.Kidney international reports · 2023Article
- Article
- Impact of body mass index on in-hospital mortality in older patients hospitalized for bacterial pneumonia with non-dialysis-dependent chronic kidney disease.BMC geriatrics · 2022Article
- Cohort Study and Bias Analysis of the Obesity Paradox Across Stages of Chronic Kidney Disease.Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation · 2022Article
- Impact of Extremes of Body Mass Index (BMI) in End-Stage Renal Disease (ESRD) Patients.Cureus · 2022Review
- Characteristics and predictors of mortality on haemodialysis in Brazil: a cohort of 5,081 incident patients.BMC nephrology · 2022Article
Corrections and comments
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Authors and funding
13 authors at 5 institutions in 2 countries.
Funding
Abstract
backgroundThe inverse association between body mass index (BMI) and mortality observed in patients treated with maintenance hemodialysis (MHD), also known as the obesity paradox, may be a result of residual confounding. Marginal structural model (MSM) analysis, a technique that accounts for time-varying confounders, may be more appropriate to investigate this association. We hypothesize that after applying MSM, the inverse association between BMI and mortality in MHD patients is attenuated.
methodsWe examined the associations between BMI and all-cause mortality among 123 624 adult MHD patients treated during 2001-6. We examined baseline and time-varying BMI using Cox proportional hazards models and MSM while considering baseline and time-varying covariates, including demographics, comorbidities and markers of malnutrition and inflammation.
resultsThe patients included 45% women and 32% African Americans with a mean age of 61(SD 15) years. In all models, BMI showed a linear incremental inverse association with mortality. Compared with the reference (BMI 25 to <27.5 kg/m(2)), a BMI of <18 kg/m(2) was associated with a 3.2-fold higher death risk [hazard ratio (HR) 3.17 (95% CI 3.05-3.29)], and mortality risks declined with increasing BMI with the greatest survival advantage of 31% lower risk [HR 0.69 (95% CI 0.64-0.75)] observed with a BMI of 40 to <45 kg/m(2).
conclusionsThe linear inverse relationship between BMI and mortality is robust across models including MSM analyses that more completely account for time-varying confounders and biases.
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