Obesity, end-stage renal disease, and survival in an elderly cohort with cardiovascular disease

Obesity (Silver Spring). 2009 Dec;17(12):2216-22. doi: 10.1038/oby.2009.70. Epub 2009 Mar 26.


Obesity is highly prevalent in African Americans and is associated with increased risk of End-Stage Renal Disease (ESRD) and death. It is not known if the effect of obesity is similar among blacks and whites. The aim of this study is to examine racial differences in the association of obesity with ESRD and survival in elderly patients (age >65). Data were obtained for 74,167 Medicare patients with acute myocardial infarction (AMI) between February 1994 and July 1995. BMI was calculated as weight (kg) divided by height (m(2)). We evaluated the association of BMI class with ESRD incidence and death using multivariable Cox proportional hazards models, testing for race-BMI interactions. Compared to whites, African Americans had higher BMI (26.9 vs. 26.0, P < 0.0001) and estimated glomerular filtration rate (72.4 ml/min/1.73 m(2) vs. 66.6 ml/min/1.73 m(2), P < 0.0001). Crude ESRD rates increased with increasing obesity among whites but not among blacks. However, after adjusting for age, sex, and other comorbidities, obesity was not associated with increased ESRD rate among blacks or whites and the interaction between race and BMI was not significant. Furthermore, for both races, patients classified as overweight, class 1 obese, or class 2 obese had similar, significantly better survival abilities compared to normal weight patients and the race BMI interaction was not significant. In conclusion, obesity does not increase risk of ESRD among black or white elderly subjects with cardiovascular disease (CVD). However, both obese blacks and whites, in this population, experience a survival benefit. Further studies need to explore this obesity paradox.

MeSH terms

  • African Americans*
  • Aged
  • Aged, 80 and over
  • Body Mass Index*
  • European Continental Ancestry Group*
  • Female
  • Glomerular Filtration Rate
  • Humans
  • Incidence
  • Kidney Failure, Chronic / ethnology
  • Kidney Failure, Chronic / etiology
  • Kidney Failure, Chronic / mortality*
  • Male
  • Myocardial Infarction / complications*
  • Obesity / complications
  • Obesity / ethnology*
  • Proportional Hazards Models
  • Survival Analysis
  • United States / epidemiology