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May 18, 2026Hemodialysis InternationalOpen Access

Associations Between Body Mass Index and Clinical Outcomes Stratified by Age in Patients Undergoing Maintenance Hemodialysis

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Why the study?

The study aimed to investigate the association between body mass index and clinical outcomes stratified by age group in patients undergoing hemodialysis.

Does body mass index affect all-cause mortality and cardiovascular events differently across age groups in patients undergoing maintenance hemodialysis?

Population

71,382 patients undergoing maintenance hemodialysis

Comparison

Underweight vs normal vs overweight vs obese BMI categories across age groups

Design

Retrospective population-based cohort study

Key result

Low body mass index was associated with higher all-cause mortality across all age groups compared to normal BMI, while overweight or obese patients had lower or comparable mortality.

Authors

SKSeok Hui KangSPSo Young ParkYLYu Jeong Lim

Discussion

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Overview

May warrant closer monitoring of underweight HD patients across ages; leaves open whether weight gain improves survival.

Key Points

  • This study investigates how body mass index affects clinical outcomes based on age in patients undergoing maintenance hemodialysis.
  • Retrospective analysis of claims and death data from 71,382 patients undergoing hemodialysis.
  • Patients categorized by age groups and body mass index into underweight, normal, overweight, and obese.
  • Multivariable Cox regression analyses were conducted to assess outcomes.
  • Underweight patients faced higher all-cause mortality across all age groups compared to normal-weight patients.
  • In patients aged <65 and 65-74 years, overweight and obese individuals had better cardiovascular event outcomes than those with normal BMI.
  • The association between BMI and cardiovascular outcomes weakened in patients aged ≥75 years.

Study Design

Type

Cohort (n=71,382)

Structured PICO

Does body mass index affect all-cause mortality and cardiovascular events differently across age groups in patients undergoing maintenance hemodialysis?

P
Population
71,382 patients undergoing maintenance hemodialysis, stratified by age (<65, 65-74, 75-84, ≥85 years)
I
Intervention
Body mass index categories (underweight, overweight, obese)
C
Comparator
Normal body mass index
O
Outcome
All-cause mortality and cardiovascular eventshard clinical

In patients undergoing maintenance hemodialysis, low BMI is associated with increased mortality across all ages, while the 'obesity paradox' for cardiovascular events is prominent in younger patients but attenuated in those aged ≥75 years.

Cite This Study

Kang et al. (2026) conducted a cohort in Maintenance hemodialysis (n=71,382). Body mass index categories (underweight, overweight, obese) vs. Normal body mass index was evaluated on All-cause mortality and cardiovascular events. Low body mass index was associated with higher all-cause mortality across all age groups compared to normal BMI, while overweight or obese patients had lower or comparable mortality.

synapsesocial.com/papers/6a0aad015ba8ef6d83b70678https://doi.org/10.1111/hdi.70081
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