BMI as an Indicator of Serum
Albumin and its Role as a Prognostic
Factor for Taiwanese Patients with
ESRD on Hemodialysis
Anny Xiao, OMS II
Yin-Cheng Chen, MD
Athena Lin, MD
Touro University College of Osteopathic Medicine
Global Health Internship Program:
Taiwan International Healthcare Training Center, Taipei, Taiwan
Background:
Kidney Disease in Taiwan
2012 USRDS Annual Data Report
Background:
Kidney Disease in Taiwan
• ESRD Prevalence: 2584 per million in 2010
• Risk factors for CKD:
• Smoking, obesity, regular herbal medicine use,
chronic lead exposure, hepatitis C, family
history of ESRD
• Dialysis: 89.6% HD & 10.4% PD patients in 2010
Background:
Kidney Disease in Taiwan
• Chinese herbal medicine use is
independently associated with CKD
in adults not using analgesics
• Consumption of Chinese herbs
containing aristolochic acid shown to
cause ESRD in Taiwan
• Aristolochic acid banned by Taiwan
DOH in 2003
• Herbal medicine perceived as less
harmful than Western medicine
Background:
BMI, Albumin, and ESRD
• BMI is predictive of mortality risk in ESRD patients
• Obesity paradox in hemodialysis patients: High BMI
associated with lower all-cause mortality rates
• Indicator of nutritional status
• Hypoalbuminemia (< 3.5 g/dL) is an independent
risk factor for morbidity and mortality
• Marker of inflammation and cardiac disease
• Possible explanations:
• Malnutrition and inflammation
• Protein-energy wasting
Background:
BMI in Taiwanese population
• World Health Organization report:
• Asians have a higher percentage of body fat than
Caucasians of the same age, sex, and BMI
• Chang et al. 2003 study conclusions:
• Taiwanese subjects had a relatively lower BMI but
a higher BF% than Caucasians
• Proposed adjusted overweight and obesity criteria
in the Taiwanese population:
• Overweight: BMI 23 kg/m2
• Obesity: BMI 25 kg/m2
Study Goals
• Determine the relationship between BMI
and serum albumin in a cohort of Taiwanese
patients by cross-sectional analysis
• Further elucidate the role of BMI as a
prognostic factor based on its relationship to
albumin
• Suggest an optimal BMI range for
hemodialysis patients on ESRD in Taiwan
Hypothesis
A body mass index > 25 kg/m2 correlates
with a higher serum albumin than a body
mass index < 25 kg/m2 in Taiwanese
ESRD patients on hemodialysis
Study Population
• Taiwanese ESRD patients receiving
hemodialysis 3 times per week at the TIHTC
Taipei Hospital Hemodialysis Center.
• N = 131
• Average age: 63.0 ± 13.1
• 55% male, 45% female
• Average length of dialysis
treatment: 4.67 years
Methods
• Data collected:
• Age
• Height and post-HD dry weight
• BMI was obtained by body weight (kg) divided
by squared body height (m2)
• Serum albumin
• Used as a marker for mortality risk
• Number of other systemic diseases
• Date of maintenance hemodialysis
initiation
Methods
• Comparison of serum albumin in:
• Patients with BMI < 25 kg/m2 (N = 81) versus
patients with BMI > 25 kg/m2 (N = 50)
• Matched for average age, number of comorbidities and
years of hemodialysis treatment
• Subgroups according to current international
BMI classification
•
•
•
•
Underweight BMI < 18.5 kg/m2 (N = 81)
Normal BMI 18.5 – 24.9 kg/m2 (N = 73)
Overweight BMI 25 – 29.9 kg/m2 (N = 44)
Obese BMI > 30 kg/m2 (N = 6)
Results
• Serum albumin in patients with BMI < 25 kg/m2
• Average: 3.37 ± 0.35 g/dl
• Median: 3.4 g/dl
• Serum albumin in patients with BMI > 25 kg/m2
• Average: 3.50 ± 0.32 g/dl
• Median: 3.5 g/dl
Serum albumin is higher in patients with
BMI > 25 kg/m2 (P = 0.019)
Results
50
47
45
Number of patients
40
35
34
32
30
25
20
18
15
10
5
0
BMI <25 kg/m2
BMI >25 kg/m2
serum albumin <3.5 g/dl
serum albumin >3.5 g/dl
Results
• Average serum albumin of BMI subgroups:
•
•
•
•
3.28 ± 0.44 g/dl for Underweight BMI < 18.5 kg/m2
3.38 ± 0.34 g/dl for Normal BMI 18.5 – 24.9 kg/m2
3.53 ± 0.32 g/dl for Overweight BMI 25 – 29.9 kg/m2
3.30 ± 0.26 g/dl for Obese BMI > 30 kg/m2
Average serum albumin (g/dl)
3.55
Overweight
3.5
18.2
3.45
21.9
3.4
27.0
Normal
31.8
3.35
3.3
Obese
Underweight
3.25
16
18
20
22
24
Average BMI
26
(kg/m2)
28
30
32
Results
• 3.53 ± 0.32 g/dl for overweight BMI 25-29.9 kg/m2
• Positive correlation of BMI and serum albumin
• R(42) = 0.4, p <0.05
30
BMI (kg/m2 )
29
28
27
26
25
24
2.4
2.6
2.8
3
3.2
3.4
Serum Albumin (g/dl)
3.6
3.8
4
4.2
Conclusions
• BMI in the overweight range (25.0 – 29.9 kg/m2)
was positively correlated with serum albumin levels
• Patients in the overweight BMI group had the
highest average serum albumin levels
BMI may be a useful prognostic factor in
Taiwanese ESRD patients
• Taiwanese ESRD patients on hemodialysis may
benefit from achieving a goal BMI of 25.0 – 29.9
kg/m2
Implications
• Body weight management and optimizing dietary nutrient
intake may help reduce high mortality rates in the
Taiwanese hemodialysis population
• Expansion of Taiwan’s nationwide CKD Preventive Project
to include dietary counseling for ESRD patients on dialysis
may improve prognosis
• Hemodialysis patients with BMI <25 kg/m2 can be
encouraged to eat more to replenish protein, energy and
nutrients
多吃!
Acknowledgements
• Touro University California, College of Osteopathic
Medicine
• Global Health Program
• Research Department
• Taiwan International Healthcare Training Center,
Taipei Hospital, Taipei, Taiwan (ROC)
• Director Yin-Cheng Chen, MD, Taipei Hospital,
Department of Nephrology
• Athena Lin, PhD, Touro University California, College of
Osteopathic Medicine, Department of Basic Sciences
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