Association of obesity with 3-month mortality in kidney failure patients with COVID-19
Authors: Tantisattamo Ekamol , Imhof Celine , Jager Kitty J , Hilbrands Luuk B , Guidotti Rebecca , Islam Mahmud , Katicic Dajana , Konings Constantijn , Molenaar Femke M , Nistor Ionut , Noordzij Marlies , Rodríguez Ferrero María Luisa , Verhoeven Martine A M , de Vries Aiko P J , Kalantar-Zadeh Kamyar , Gansevoort Ron T , Vart Priya ,   ERACODA collaborators, van der Net Jeroen B , Essig Marie , du Buf-Vereijken Peggy W G , van Ginneken Betty , Maas Nanda , van Jaarsveld Brigit C , Bemelman Frederike J , Klingenberg-Salahova Farah , Heenan-Vos Frederiek , Vervloet Marc G , Nurmohamed Azam , Vogt Liffert , Abramowicz Daniel , Verhofstede Sabine , Maoujoud Omar , Malfait Thomas , Fialova Jana , Melilli Edoardo , Favà Alexandre , Cruzado Josep M , Perez Nuria Montero , Lips Joy , Krepel Harmen , Adilovic Harun , Radulescu Daniela , Hengst Maaike , Rydzewski Andrzej , Braconnier Philippe , Weis Daniel , Gellert Ryszard , Oliveira João , Alferes Daniela G , Zakharova Elena V , Ambuehl Patrice Max , Walker Andrea , Lepeytre Fanny , Rabaté Clémentine , Rostoker Guy , Marques Sofia , Azasevac Tijana , Majstorovic Gordana Strazmester , ten Dam Marc , Krüger Thilo , Brzosko Szymon , Liakopoulos Vassilios , Zanen Adriaan L , Logtenberg Susan J J , Fricke Lutz , Kuryata Olexandr , Slebe Jeroen J P , ElHafeez Samar Abd , Kemlin Delphine , van de Wetering Jacqueline , Reinders Marlies E J , Hesselink Dennis A , Kal-van Gestel J , Eiselt Jaromir , Kielberger Lukas , El-Wakil Hala S , Logan Ian , Canal Cristina , Facundo Carme , Ramos Ana M , Debska-Slizien Alicja , Veldhuizen Nicoline M H , Tigka Eirini , Konsta Maria Anna Polyzou , Panagoutsos Stylianos , Mallamaci Francesca , Postorino Adele , Cambareri Francesco , Matceac Irina , Covic Adrian , Groeneveld J H M , Jousma Jolanda , van Buren Marjolijn , Diekmann Fritz , Oppenheimer Federico , Blasco Miquel , Pereira Tiago Assis , Santos Augusto Cesar S , Arias-Cabrales Carlos , Crespo Marta , Llinàs-Mallol Laura , Buxeda Anna , Tàrrega Carla Burballa , Redondo-Pachon Dolores , Jimenez Maria Dolores Arenas , Mendoza-Valderrey Alberto , Martins Ana Cristina , Mateus Catarina , Alvila Goncalo , Laranjinha Ivo , Hofstra Julia M , Siezenga Machiel A , Franco Antonio , Arroyo David , Castellano Sandra , Manzanos Sagrario Balda , Haridian Sosa Barrios R , Lemahieu Wim , Bartelet Karlijn , Dirim Ahmet Burak , Demir Erol , Sever Mehmet Sukru , Turkmen Aydin , Şafak Seda , Hollander Daan A M J , Büttner Stefan , Meziyerh Soufian , van der Helm Danny , Mallat Marko , Bouwsma Hanneke , Sridharan Sivakumar , Petruliene Kristina , Maloney Sharon-Rose , Verberk Iris , van der Sande Frank M , Christiaans Maarten H L , Hemmelder Marc H , Kumar N Mohan , Di Luca Marina , Tuğlular Serhan Z , Ziekenhuis Martini , Kramer Andrea B , Beerenhout Charles , Luik Peter T , Kerschbaum Julia , Tiefenthaler Martin , Watschinger Bruno , Adema Aaltje Y , Stepanov Vadim A , Zulkarnaev Alexey B , Turkmen Kultigin , Gandolfini Ilaria , Maggiore Umberto , Fliedner Anselm , Åsberg Anders , Mjoen Geir , Miyasato Hitoshi , de Fijter Carola W H , Mongera Nicola , Pini Stefano , de Biase Consuelo , Kerckhoffs Angele , Els van de Logt Anne , Maas Rutger , Duivenvoorden Raphaël , Lebedeva Olga , Lopez Veronica , Reichert Louis J M , Verhave Jacobien , Titov Denis , Parshina Ekaterina V , Zanoli Luca , Marcantoni Carmelita , van Kempen Gijs , van Gils-Verrij Liesbeth E A , Harty John C , Meurs Marleen , Myslak Marek , Battaglia Yuri , Lentini Paolo , den Deurwaarder Edwin , Stendahl Maria , Rahimzadeh Hormat , Schouten Marcel , Rychlik Ivan , Cabezas-Reina Carlos J , Roca Ana Maria , Nauta Ferdau , Sahin İdris , Goffin Eric , Kanaan Nada , Labriola Laura , Devresse Arnaud , Diaz-Mareque Anabel , Coca Armando , de Arriba Gabriel , Meijers Björn K I , Naesens Maarten , Kuypers Dirk , Desschans Bruno , Tonnerlier Annelies , Wissing Karl M , Dedinska Ivana , Pessolano Giuseppina , Malik Shafi , Dounousi Evangelia , Papachristou Evangelos , Berger Stefan P , Meijer Esther , Sanders Jan Stephan F , Franssen Casper F M , Özyilmaz Akin , Ponikvar Jadranka Buturović , Pernat Andreja Marn , Kovac Damjan , Arnol Miha , Ekart Robert , Abrahams Alferso C , van Zuilen Arjan D , Meijvis Sabine C A , Dolmans Helma , Esposito Pasquale , Krzesinski Jean-Marie , Barahira Jean Damacène , Gallieni Maurizio , Martin-Moreno Paloma Leticia , Guglielmetti Gabriele , Guzzo Gabriella , Toapanta Nestor , Soler Maria Jose , Luik Antinus J , van Kuijk Willi H M , Stikkelbroeck Lonneke W H , Hermans Marc M H , Rimsevicius Laurynas , Righetti Marco , Heitink-ter Braak Nicole 
Published: March 2022

ABSTRACT

Background
In the general population with coronavirus disease 2019 (COVID-19), obesity is associated with an increased risk of mortality. Given the typically observed obesity paradox among patients on kidney function replacement therapy (KFRT), especially dialysis patients, we examined the association of obesity with mortality among dialysis patients or living with a kidney transplant with COVID-19.

Methods
Data from the European Renal Association COVID-19 Database (ERACODA) were used. KFRT patients diagnosed with COVID-19 between 1 February 2020 and 31 January 2021 were included. The association of Quetelet's body mass index (BMI) (kg/m2), divided into: &lt;18.5 (lean), 18.5–24.9 (normal weight), 25–29.9 (overweight), 30–34.9 (obese I) and ≥35 (obese II/III), with 3-month mortality was investigated using Cox proportional-hazards regression analyses.

Results
In 3160 patients on KFRT (mean age: 65 years, male: 61%), 99 patients were lean, 1151 normal weight (reference), 1160 overweight, 525 obese I and 225 obese II/III. During follow-up of 3 months, 28, 20, 21, 23 and 27% of patients died in these categories, respectively. In the fully adjusted model, the hazard ratios (HRs) for 3-month mortality were 1.65 [95% confidence interval (CI): 1.10, 2.47], 1 (ref.), 1.07 (95% CI: 0.89, 1.28), 1.17 (95% CI: 0.93, 1.46) and 1.71 (95% CI: 1.27, 2.30), respectively. Results were similar among dialysis patients (N = 2343) and among those living with a kidney transplant (N = 817) (Pinteraction = 0.99), but differed by sex (Pinteraction = 0.019). In males, the HRs for the association of aforementioned BMI categories with 3-month mortality were 2.07 (95% CI: 1.22, 3.52), 1 (ref.), 0.97 (95% CI: 0.78. 1.21), 0.99 (95% CI: 0.74, 1.33) and 1.22 (95% CI: 0.78, 1.91), respectively, and in females corresponding HRs were 1.34 (95% CI: 0.70, 2.57), 1 (ref.), 1.31 (95% CI: 0.94, 1.85), 1.54 (95% CI: 1.05, 2.26) and 2.49 (95% CI: 1.62, 3.84), respectively.

Conclusion
In KFRT patients with COVID-19, on dialysis or a kidney transplant, obesity is associated with an increased risk of mortality at 3 months. This is in contrast to the obesity paradox generally observed in dialysis patients. Additional studies are required to corroborate the sex difference in the association of obesity with mortality.