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Study published in Mayo Clinic Proceedings

A study by Dr. Kamyar Kalantar-Zadeh, chief of UC Irvine’s Division of Nephrology, Hypertension & Kidney Transplantation, is featured in the May 2013 issue of Mayo Clinic Proceedings. The study, a collaborative effort with South Korean colleagues, expands the understanding of the obesity paradox in patients receiving hemodialysis.

Dr. Kamyar Kalantar-Zadeh
Dr. Kam Kalantar-Zadeh, chief of the Division of Nephrology

Proceedings, the flagship journal of Mayo Clinic, is among the most widely read and highly cited scientific publications for physicians, with a circulation of approximately 124,000.

The objective of the study was to determine whether weight gain accompanied by an increase in muscle mass is associated with a survival benefit in patients receiving maintenance hemodialysis (HD).

The article was titled “The Obesity Paradox and Mortality Associated With Surrogates of Body Size and Muscle Mass in Patients Receiving Hemodialysis,” and examined a nationally representative 5-year cohort of 121,762 patients receiving hemodialysis three times weekly from July 1, 2001, through June 30, 2006.

Study results show that in the cohort, higher BMI (up to 45) and higher serum creatinine concentration were incrementally and independently associated with greater survival, even after extensive adjustment for nutritional status and inflammation.

Dry weight loss or gain over time exhibited a graded association with higher rates of mortality or survival, respectively, as did changes in serum creatinine level over time. Among the 50,831 patients who survived the first 6 months and who had available data for changes in weight and creatinine level, those who lost weight but had an increased serum creatinine level had a greater survival rate than those who gained weight but had a decreased creatinine level. These associations appeared consistent across different demographic groups of patients receiving hemodialysis

The conclusion of the study was that, in patients receiving long-term HD, larger body size with more muscle mass appears associated with a higher survival rate. A discordant muscle gain with weight loss over time may confer more survival benefit than weight gain while losing muscle. The study concluded that controlled trials of muscle-gaining interventions in patients receiving HD are warranted.

Proceedings, which has been continuously published since 1926, includes Nobel-prize-winning research and has improved its rating from the 13th position out of 153 to 11th position out of 155 journals in the "Medicine, General & Internal" category.