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Intensive Care Medicine
Published in: Intensive Care Medicine 7/2010

01-07-2010 | Original

Impact of body mass on incidence and prognosis of acute kidney injury requiring renal replacement therapy

Authors: Wilfred Druml, Barbara Metnitz, Eva Schaden, Peter Bauer, Philipp G. H. Metnitz

Published in: Intensive Care Medicine | Issue 7/2010

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Abstract

Purpose

In patients with chronic kidney disease, survival has been shown to be better with increasing body mass, an observation which was termed the “obesity paradox”. To investigate if such an effect would also be present in patients with acute kidney injury (AKI), we analysed the impact of body mass on the prognosis of intensive care patients with severe AKI requiring renal replacement therapy.

Methods

A total of 5,232 patients with AKI requiring renal replacement therapy from 53 Austrian ICUs were analysed.

Results

Patients were divided into one of five BMI groups: underweight, normal, overweight, obese and morbid obese. The incidence of AKI increased with increasing body mass from underweight, normal (5.4%) to morbid obese (11.8%). Moreover, adjusted odds ratios to develop AKI were significantly increased for all groups (reference group: normal). Risk-adjusted hospital mortality rates followed a U-shaped pattern, with the lowest mortality in obese patients (BMI of ≥ 30 < 35). Multivariate analysis (with adjustment for severity of illness, sex, reason for admission and comorbidities) confirmed these results: obese patients presented with a significantly reduced probability to die in the hospital [odds ratio 0.81 (0.66–0.98)].

Conclusions

Obesity is an independent risk factor for developing AKI. Our results provide further evidence that body mass impacts on survival of patients with AKI requiring renal replacement therapy. Obese patients seem to have a survival benefit compared to underweight or normal weight patients.
Appendix
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Metadata
Title
Impact of body mass on incidence and prognosis of acute kidney injury requiring renal replacement therapy
Authors
Wilfred Druml
Barbara Metnitz
Eva Schaden
Peter Bauer
Philipp G. H. Metnitz
Publication date
01-07-2010
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 7/2010
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-010-1844-2

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