Lean Body Mass and Survival in Hemodialysis Patients and the Roles of Race and Ethnicity

Background: Lean body mass (LBM) represents the fat-free'' muscle mass in hemodialysis (HD) patients and is an important nutritional measure. Previous studies have found that both higher LBM and body mass index (BMI) were related to greater survival in HD patients. Additional studies have shown differences in survival across racial-ethnic groups of HD patients. However, the association of LBM and mortality across racial-ethnic subgroups has not been examined. Objective: We hypothesize that racial differences in LBM affect the mortality in HD patients. Setting and Subjects: Chronic HD patients from a large dialysis organization in the United States. Predictors: Estimated LBM (eLBM), self-identified racial subgroups. Main Outcome Measure: 5-year survival. Study Design: We examined the association between baseline eLBM and survival using Cox proportional hazard models adjusted for demographics, comorbidities, and laboratory measures. Associations were examined across subgroups of race-ethnicity (non-Hispanic white, African American, and Hispanic) and BMI. Results: The final cohort included 117,683 HD patients, who were 62 6 15 (mean 6 standard deviation) years old, 43% women and 59% with diabetes mellitus. Higher eLBM was linearly associated with lower mortality. Compared with the reference group (48.4-<50.5 kg), patients with the lowest eLBM (<41.3 kg) had a 1.4-fold higher risk of mortality (hazard ratio: 1.37; 95% confidence interval: 1.30-1.44) in the fully adjusted model. A similar linear association was seen among patients with BMI, 35 kg/m(2) and in non-Hispanic whites and African American subgroups. However, higher eLBM was not associated with improved survival in Hispanic patients or patients with BMI >= 35 kg/m(2). Limitation: Potential residual confounding. Conclusions: Higher eLBM is associated with a lower mortality risk in HD patients, especially among non-Hispanic white and African American groups. Hispanic patients do not demonstrate a similar inverse relationship. The association between LBM and mortality among different racial groups of HD patients deserves additional study. (C) 2016 by the National Kidney Foundation, Inc. All rights reserved.