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Updated: Aug 27, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Low Body Mass Index without Malnutrition Is an Independent Risk Factor for Major Cardiovascular Events in Patients
Takuya Kishi1, Akira Kitajima1,2, Kohei Yamanouchi1
1International University of Health and Welfare Graduate School of Medicine.
Insights
Low body mass index (BMI) under 18.5, without malnutrition, may be an independent risk factor for major cardiovascular events (MACE) in hemodialysis patients. This finding highlights a critical area for intervention in this vulnerable population.
Area of Science:
- Nephrology
- Cardiology
- Internal Medicine
Background:
- Major cardiovascular events (MACE) are a leading cause of morbidity and mortality in patients undergoing hemodialysis.
- Identifying modifiable risk factors for MACE is crucial for improving patient outcomes in chronic kidney disease populations.
Purpose of the Study:
- To investigate the risk factors associated with MACE in patients undergoing maintenance hemodialysis.
- To explore the association between body mass index (BMI) and MACE in this patient cohort.
Main Methods:
- Retrospective analysis of 132 hemodialysis patients over a 3-year follow-up period (June 2017 - June 2020).
- Data collection included incidence of MACE (cardiac death, myocardial infarction, revascularization, heart failure hospitalization, stroke) and clinical indicators.
- Statistical analysis included univariate and multivariable logistic regression to identify independent risk factors for MACE.
Main Results:
- A total of 31 patients (23.5%) experienced MACE during the study period.
- Patients with MACE had a significantly lower BMI (< 18.5), longer duration of dialysis, and a history of gastrointestinal bleeding.
- Multivariable analysis identified BMI < 18.5 as an independent risk factor for MACE, even in the absence of malnutrition markers.
Conclusions:
- A low BMI (< 18.5) is a significant independent risk factor for major cardiovascular events in hemodialysis patients.
- This finding suggests that maintaining an adequate BMI may be important for cardiovascular health in patients on hemodialysis.
- Further prospective studies are warranted to confirm these findings and explore potential underlying mechanisms.
Abstract:
We retrospectively analyzed major cardiovascular events (MACE), a composite of cardiac death, nonfatal myocardial infarction, unplanned revascularization, heart failure leading to hospitalization, and stroke during a 3-year follow-up of patients with hemodialysis at the dialysis center of our general hospital that can treat comprehensive diseases. Moreover, we conducted an exploratory study that focuses on the risk factor for MACE in patients with hemodialysis.A total of 132 patients with hemodialysis at our dialysis center as of June 2017 were included in the study. Data on event incidence, including death and various clinical indicators, were collected in the electronic medical record for three years until June 2020. Between June 2017 and June 2020, of the 132 patients with hemodialysis, 31 patients experienced MACE (10 cardiovascular deaths, 3 nonfatal myocardial infarction, 11 unplanned revascularizations, 5 heart failure leading to hospitalization, and 2 stroke). The patients with MACE had a lower body mass index (BMI), longer duration of dialysis with more preexisting gastrointestinal (GI) bleeding, and took more aspirin compared to the MACE-free patients. Malnutrition markers (serum total protein, serum albumin, and serum total cholesterol) were similar in both groups. In a univariate analysis for MACE, the odds ratio was significantly higher for BMI < 18.5, duration of hemodialysis, and history of GI bleeding. Multivariable-adjusted odds ratios for MACE were significantly higher for BMI < 18.5.In conclusion, BMI < 18.5 without malnutrition may be an independent risk factor for MACE in patients with hemodialysis.
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