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제목	Low Body Mass Index with Low Serum Creatinine level is Associated with Higher Mortality Rate in Hemodialysis Patients: A Korean, Nationwide, Population-based Analysis
저자	Young Eun Kwon, Min-Ho Kim, Young Su Joo, Hye Min Choi, Dong-Jin Oh, Dong-Ryeol Ryu
출판정보	2020; 2020(1):
키워드	Hemodialysis \| Creatinine \| Body mass index \| Muscle \| Mortality
초록	Low body mass index (BMI) is a risk factor for mortality in chronic kidney disease patients. In addition, recent studies showed that low muscle mass might be associated with adverse outcomes, and serum creatinine level is considered as an indicator of muscle mass in hemodialysis (HD) patients. We aimed to determine the effect of serum creatinine levels on overall mortality and mortality between BMI groups. Prevalent patients' data for HD quality assessment which was performed from October to December 2013 were retrieved from the Korean Health Insurance Review and Assessment Service database, and mortality data were collected until December 2017. The patients were classified into three groups according to the BMI; underweight (<18.5kg/m2), normal (18.5~22.9kg/m2), and overweight (≥23kg/m2) groups. Creatinine levels were divided into three groups according to the tertiles; low, medium and high group. We compared the effect of serum creatinine on overall crude mortality rate, mortality rate according to the BMI groups. Moreover, propensity score matching analysis was performed for adjusting age, gender, diabetes mellitus and dialysis vintage. Cox proportional hazard regression analyses were conducted. A total 21,618 patients were included in this study, and mean age was 59.3±13.0 years old. Table 1 showed that crude death rate of low creatinine group was higher than medium and high creatinine group in all BMI group. Among low creatinine groups, underweight group showed highest crude death rate. By univariate and multivariate Cox regression analyses, low and medium creatinine group showed statistically higher hazard ratio compared to high creatinine group. Even after propensity score matching, all-cause mortality risk of low and medium creatinine groups were still higher than high creatinine group (Table 2) Low creatinine level was associated with higher mortality risk in HD patients, and low creatinine with low BMI HD patients showed highest mortality risk.
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