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Impact of Percent Body Fat on All-Cause Mortality among Adequate Dialysis Patients with and without Insulin Resistance: A Multi-Center Prospective Cohort Study

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School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei 110, Taiwan
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Department of Nutrition and Health Sciences, Chinese Culture University, Taipei 110, Taiwan
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Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
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Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei 110, Taiwan
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Department of Nephrology, Taipei Medical University-Wan Fang Hospital, Taipei 110, Taiwan
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Division of Nephrology, Department of Internal Medicine, Taipei Medical University—Shuang Ho Hospital, Taipei 110, Taiwan
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Division of Nephrology, Cathay General Hospital, Taipei 110, Taiwan
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Division of Nephrology, Taipei Tzu-Chi Hospital, New Taipei 231, Taiwan
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Department of Nephrology, Wei Gong Memorial Hospital, Miaoli 351, Taiwan
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Department of Nephrology, Lotung Poh-Ai Hospital, Yilan 265, Taiwan
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Research Center of Geriatric Nutrition, Taipei Medical University, Taipei 110, Taiwan
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Nutrition Research Center, Taipei Medical University Hospital, Taipei 110, Taiwan
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Author to whom correspondence should be addressed.
Nutrients 2019, 11(6), 1304; https://doi.org/10.3390/nu11061304
Received: 21 May 2019 / Revised: 4 June 2019 / Accepted: 4 June 2019 / Published: 9 June 2019
The association between body fat and mortality in hemodialysis patients remains controversial. We examined the effect of percent body fat (PBF) on all-cause mortality among adequate hemodialysis patients with and without insulin resistance (IR). A prospective cohort study was conducted on 365 adequate hemodialysis patients (equilibrated Kt/V ≥ 1.2) from seven hospitals. Patients’ characteristics and clinical and biochemical parameters were assessed at baseline between September 2013 and April 2017. Patients were followed up for all-cause mortality until April 2018. The median value of homeostatic model assessment (HOMA-IR) was used to classify IR. Cox proportional hazard models were utilized to examine predictors of all-cause mortality. During 1.4 (1.0–3.2) years of follow-up, 46 patients died. In patients with IR (HOMA-IR ≥ 5.18), PBF was significantly higher in the survival group than in the death group (31.3 ± 9.0 vs. 25.4 ± 8.2, p = 0.005). After controlling for confounding factors, PBF was significantly associated with lower risk for all-cause mortality in patients with IR (hazard ratio, 0.94; 95% confidence interval, 0.89–1.00; p = 0.033). The association was not observed in patients without IR. In conclusion, percent body fat shows a protective effect on survival in hemodialysis patients with IR. View Full-Text
Keywords: percent body fat; obesity; insulin resistance; HOMA-IR; all-cause mortality; hemodialysis; mortality; survival; dialysis adequacy; multi-center percent body fat; obesity; insulin resistance; HOMA-IR; all-cause mortality; hemodialysis; mortality; survival; dialysis adequacy; multi-center
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Duong, T.V.; Wong, T.-C.; Chen, H.-H.; Chen, T.-H.; Hsu, Y.-H.; Peng, S.-J.; Kuo, K.-L.; Liu, H.-C.; Lin, E.-T.; Yang, S.-H. Impact of Percent Body Fat on All-Cause Mortality among Adequate Dialysis Patients with and without Insulin Resistance: A Multi-Center Prospective Cohort Study. Nutrients 2019, 11, 1304.

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