Association between abdominal obesity indicators and survival among individuals undergoing hemodialysis: Retrospective observational cohort study

Background Individuals with chronic kidney disease undergoing hemodialysis frequently present with obesity and altered fat distribution, which contributes to metabolic and cardiovascular complications. Although body mass index (BMI) is widely used, it does not capture abdominal adiposity, and the prognostic utility of alternative anthropometric indicators remains uncertain. This study analyzes the effects of abdominal obesity indicators on all‐cause mortality in individuals undergoing hemodialysis. Methods A retrospective cohort study was undertaken, with a sample of 1024 individuals of whom 375 died during the 36‐month observation period. The outcomes analyzed were all‐cause mortality, according to the ICD‐10 classification. Indicators of general and abdominal obesity, such as BMI, waist circumference (WC), waist‐to‐height ratio (WHtR), and conicity index (CI), were evaluated, with specific cutoff points for this population. Statistical analysis involved Kaplan–Meier curves and Cox regression model, with verification of model assumptions. The analyses were performed in R software with a significance level of 5%. Results The prevalence of abdominal obesity was high, with 77.3% having an increased WHtR, 62.1% presenting an elevated CI, and 60.7% showing an increased WC. Kaplan–Meier curve analysis indicated that individuals with a high CI had lower survival over time. Cox regression analysis revealed that an increased CI was significantly associated with a 49.7% higher risk of all‐cause mortality ( P = 0.04), whereas WC and WHtR showed no significant association with mortality. Conclusion Abdominal obesity assessed by high CI was associated with lower survival in individuals on hemodialysis.