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Obese trauma patients have increased need for dialysis
Ahmed Farhat1, Areg Grigorian2, Ninh T Nguyen2
1Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine Medical Center, 333 The City Blvd West, Suite 1600, Orange, CA, 92868-3298, USA. amfarhat@uci.edu.
Summary
Higher body mass index (BMI) in trauma patients increases the need for dialysis. While obesity may reduce mortality risk, morbid obesity significantly elevates it, indicating a BMI threshold for survival after trauma.
Area of Science:
- Trauma surgery
- Nephrology
- Obesity medicine
Background:
- Obesity is a known risk factor for acute kidney injury.
- The impact of obesity on dialysis requirements and mortality in trauma patients remains unclear.
Purpose of the Study:
- To investigate the association between body mass index (BMI) and the need for hemodialysis in trauma patients.
- To determine the relationship between BMI and mortality risk following trauma.
Main Methods:
- Retrospective analysis of the National Trauma Data Bank.
- Patients (≥8 years) categorized by BMI: normal (18.5-24.99 kg/m²), obese (30-34.99 kg/m²), severely obese (35-39.99 kg/m²), and morbidly obese (≥40 kg/m²).
- Primary outcome: hemodialysis initiation; Secondary outcome: in-hospital mortality.
Main Results:
- Nearly 1 million trauma patients analyzed; 57.8% had normal BMI, while obese categories comprised 42.2%.
- Hemodialysis rates increased stepwise with BMI: obese (OR 1.36), severely obese (OR 1.89), and morbidly obese (OR 2.04).
- Mortality risk decreased in obese patients (OR 0.92), remained similar in severely obese (OR 1.02), and increased in morbidly obese patients (OR 1.06).
Conclusions:
- Obesity is significantly associated with a higher risk of requiring dialysis post-trauma.
- Mortality risk in trauma patients shows an inflection point related to BMI, decreasing with obesity but increasing with morbid obesity.
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