Association of obesity with 3-month mortality in kidney failure patients with COVID-19

Ekamol Tantisattamo; Celine Imhof; ERACODA Collaborators; Kitty J. Jager; Luuk B. Hilbrands; Rebecca Guidotti; Mahmud Islam; Dajana Katicic; Constantijn Konings; Femke M. Molenaar; Ionut Nistor; Marlies Noordzij; Mariá Luisa Rodríguez Ferrero; Martine A.M. Verhoeven; Aiko P.J. De Vries; Kamyar Kalantar-Zadeh; Ron T. Gansevoort; Priya Vart; Jeroen B. Van Der Net; Marie Essig; Peggy W.G. Du Buf-Vereijken; Betty Van Ginneken; Nanda Maas; Brigit C. Van Jaarsveld; Frederike J. Bemelman; Farah Klingenberg-Salahova; Frederiek Heenan-Vos; Marc G. Vervloet; Azam Nurmohamed; Liffert Vogt; Daniel Abramowicz; Sabine Verhofstede; Omar Maoujoud; Thomas Malfait; Jana Fialova; Edoardo Melilli; Alexandre Favà; Josep M. Cruzado; Nuria Montero Perez; Joy Lips; Harmen Krepel; Harun Adilovic; Daniela Radulescu; Jacqueline Van De Wetering; Marlies E.J. Reinders; Dennis A. Hesselink; J. Kal-Van Gestel; J. H.M. Groeneveld; Stefan Büttner; Stefan P. Berger; Esther Meijer

doi:10.1093/ckj/sfac083

Association of obesity with 3-month mortality in kidney failure patients with COVID-19

Ekamol Tantisattamo^*, Celine Imhof, ERACODA Collaborators, Kitty J. Jager, Luuk B. Hilbrands, Rebecca Guidotti, Mahmud Islam, Dajana Katicic, Constantijn Konings, Femke M. Molenaar, Ionut Nistor, Marlies Noordzij, Mariá Luisa Rodríguez Ferrero, Martine A.M. Verhoeven, Aiko P.J. De Vries, Kamyar Kalantar-Zadeh, Ron T. Gansevoort, Priya Vart, Jeroen B. Van Der Net, Marie EssigPeggy W.G. Du Buf-Vereijken, Betty Van Ginneken, Nanda Maas, Brigit C. Van Jaarsveld, Frederike J. Bemelman, Farah Klingenberg-Salahova, Frederiek Heenan-Vos, Marc G. Vervloet, Azam Nurmohamed, Liffert Vogt, Daniel Abramowicz, Sabine Verhofstede, Omar Maoujoud, Thomas Malfait, Jana Fialova, Edoardo Melilli, Alexandre Favà, Josep M. Cruzado, Nuria Montero Perez, Joy Lips, Harmen Krepel, Harun Adilovic, Daniela Radulescu, Jacqueline Van De Wetering, Marlies E.J. Reinders, Dennis A. Hesselink, J. Kal-Van Gestel, J. H.M. Groeneveld, Stefan Büttner, Stefan P. Berger, Esther Meijer

^*Corresponding author for this work

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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	https://doi.org/10.1093/ckj/sfac083
Publication status	Published - 1 Jul 2022

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© 2022 The Author(s). Published by Oxford University Press on behalf of the ERA.

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Tantisattamo, E., Imhof, C., ERACODA Collaborators, Jager, K. J., Hilbrands, L. B., Guidotti, R., Islam, M., Katicic, D., Konings, C., Molenaar, F. M., Nistor, I., Noordzij, M., Rodríguez Ferrero, M. L., Verhoeven, M. A. M., De Vries, A. P. J., Kalantar-Zadeh, K., Gansevoort, R. T., Vart, P., Van Der Net, J. B., ... Meijer, E. (2022). Association of obesity with 3-month mortality in kidney failure patients with COVID-19. Clinical Kidney Journal, 15(7), 1348-1360. https://doi.org/10.1093/ckj/sfac083

@article{ff3452f057a24164b476798caf040966,

title = "Association of obesity with 3-month mortality in kidney failure patients with COVID-19",

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.",

author = "Ekamol Tantisattamo and Celine Imhof and {ERACODA Collaborators} and Jager, {Kitty J.} and Hilbrands, {Luuk B.} and Rebecca Guidotti and Mahmud Islam and Dajana Katicic and Constantijn Konings and Molenaar, {Femke M.} and Ionut Nistor and Marlies Noordzij and {Rodr{\'i}guez Ferrero}, {Mari{\'a} Luisa} and Verhoeven, {Martine A.M.} and {De Vries}, {Aiko P.J.} and Kamyar Kalantar-Zadeh and Gansevoort, {Ron T.} and Priya Vart and {Van Der Net}, {Jeroen B.} and Marie Essig and {Du Buf-Vereijken}, {Peggy W.G.} and {Van Ginneken}, Betty and Nanda Maas and {Van Jaarsveld}, {Brigit C.} and Bemelman, {Frederike J.} and Farah Klingenberg-Salahova and Frederiek Heenan-Vos and Vervloet, {Marc G.} and Azam Nurmohamed and Liffert Vogt and Daniel Abramowicz and Sabine Verhofstede and Omar Maoujoud and Thomas Malfait and Jana Fialova and Edoardo Melilli and Alexandre Fav{\`a} and Cruzado, {Josep M.} and Perez, {Nuria Montero} and Joy Lips and Harmen Krepel and Harun Adilovic and Daniela Radulescu and {Van De Wetering}, Jacqueline and Reinders, {Marlies E.J.} and Hesselink, {Dennis A.} and {Kal-Van Gestel}, J. and Groeneveld, {J. H.M.} and Stefan B{\"u}ttner and Berger, {Stefan P.} and Esther Meijer",

note = "Publisher Copyright: {\textcopyright} 2022 The Author(s). Published by Oxford University Press on behalf of the ERA.",

year = "2022",

month = jul,

day = "1",

doi = "10.1093/ckj/sfac083",

language = "English",

volume = "15",

pages = "1348--1360",

journal = "Clinical Kidney Journal",

issn = "2048-8505",

publisher = "Oxford University Press",

number = "7",

}

Tantisattamo, E, Imhof, C, ERACODA Collaborators, Jager, KJ, Hilbrands, LB, Guidotti, R, Islam, M, Katicic, D, Konings, C, Molenaar, FM, Nistor, I, Noordzij, M, Rodríguez Ferrero, ML, Verhoeven, MAM, De Vries, APJ, Kalantar-Zadeh, K, Gansevoort, RT, Vart, P, Van Der Net, JB, Essig, M, Du Buf-Vereijken, PWG, Van Ginneken, B, Maas, N, Van Jaarsveld, BC, Bemelman, FJ, Klingenberg-Salahova, F, Heenan-Vos, F, Vervloet, MG, Nurmohamed, A, Vogt, L, Abramowicz, D, Verhofstede, S, Maoujoud, O, Malfait, T, Fialova, J, Melilli, E, Favà, A, Cruzado, JM, Perez, NM, Lips, J, Krepel, H, Adilovic, H, Radulescu, D, Van De Wetering, J, Reinders, MEJ, Hesselink, DA , Kal-Van Gestel, J, Groeneveld, JHM, Büttner, S, Berger, SP & Meijer, E 2022, 'Association of obesity with 3-month mortality in kidney failure patients with COVID-19', Clinical Kidney Journal, vol. 15, no. 7, pp. 1348-1360. https://doi.org/10.1093/ckj/sfac083

TY - JOUR

T1 - Association of obesity with 3-month mortality in kidney failure patients with COVID-19

AU - Tantisattamo, Ekamol

AU - Imhof, Celine

AU - ERACODA Collaborators

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 - Van De Wetering, Jacqueline

AU - Reinders, Marlies E.J.

AU - Hesselink, Dennis A.

AU - Kal-Van Gestel, J.

AU - Groeneveld, J. H.M.

AU - Büttner, Stefan

AU - Berger, Stefan P.

AU - Meijer, Esther

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.

UR - http://www.scopus.com/inward/record.url?scp=85142628371&partnerID=8YFLogxK

U2 - 10.1093/ckj/sfac083

DO - 10.1093/ckj/sfac083

M3 - Article

C2 - 35747092

AN - SCOPUS:85142628371

SN - 2048-8505

VL - 15

SP - 1348

EP - 1360

JO - Clinical Kidney Journal

JF - Clinical Kidney Journal

IS - 7

ER -

Association of obesity with 3-month mortality in kidney failure patients with COVID-19

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