Waist circumference proved to be more strongly linked to mortality than BMI among patients with kidney disease, data indicate.

Holly Kramer, MD, MPH, of Loyola University Medical Center in Maywood, Ill., and colleagues analyzed data from 5,805 adults with chronic kidney disease stages 1 through 4 who were aged 45 years and older. All participants had a BMI of 18.5 or higher.

Over a median follow-up period of four years, 686 participants (11.8%) died. The average BMI of the deceased patients was 29.2 — lower than the average BMI of 30.3 among the survivors. However, the deceased patients had an average waist circumference of 40.1 inches, compared with 39.1 for the survivors.

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Women with waists equal to or greater than 42.5 inches and men with waists equal to or greater than 48 inches were 2.1 times more likely to die than were those women with waists smaller than 31.5 inches and men with waists smaller than 37 inches, the researchers determined.

Whereas BMI reflects several components, including muscle mass and abdominal fat, waist circumference reflects abdominal adiposity only. “Waist circumference should be considered in conjunction with BMI when assessing mortality risk associated with obesity in adults with chronic kidney disease,” the researchers wrote.

Kramer H et al. Am J Kidney Dis. 2011; 58:177-185.