Body fat percentage as a risk factor for atherosclerosis but not for inflammation for hemodialysis patients: differences between genders

Introduction: Atherosclerosis (AS) and malnutrition are 2 major causes of morbidity and mortality in hemodialysis (HD) patients. A high body fat percentage (BFP) may be paradoxically associated with improved survival in chronic HD patients. We aimed to establish BFP profile of the HD patients by using bioimpedance analysis, body mass index (BMI), and waist/hip ratio (WHR) to find out their association with inflammation and AS.

Methods: In total, 125 HD patients (64 male, 51% mean age of 49.7 ± 12.3 years) were included in the study. Malnutrition-inflammation score (MIS) has been used and supported with biochemical parameters: C-reactive protein, serum iron, total iron binding capacity, ferritin, complete blood count, serum albumin, total cholesterol, low- and high-density lipoproteins, and triglyceride. The patients were divided into 3 groups according to their BFP that were defined by bioimpedance analysis. We also compared these groups according to BMI percentiles. Independent variables affecting BMI and MIS were identified by logistic regression analysis.

Results: AS was correlated with high BFP for our female HD patients, but not for the males. BFP, BMI, and WHR were significantly higher for females. Older age (P = .02), BMI (P < .01), WHR (P < .01), total leukocyte count (P = .02), serum iron (P < .01), and total iron-binding capacity (P = .02) were found significantly correlated with higher BFP for female HD patients, whereas only BMI (P < .01) and serum creatinine levels (P = .04) were significant for male patients. In logistic regression analysis, independent factors affecting cardiovascular disease (CVD) were gender, BFP, MIS, and lymphocyte/leukocyte ratio. Independent factors affecting MIS were gender, BFP, CVD, serum albumin level, and serum C-reactive protein.

Conclusion: BFP and male gender may be contributing factors for CVD; however, female HD patients with high BFP had higher risk of CVD than male counterparts. Further studies are needed to evaluate the pathophysiology of this discrepancy between genders.