U-Shaped Association of Body Mass Index With Inflammation and Atherosclerosis in Hemodialysis Patients Serkan Kahraman, MD,* Rahmi Yilmaz, MD,† Devrim Akinci, MD,‡ Mustafa Arici, MD,§ Bulent Altun, MD, Yunus Erdem, MD,¶ Unal Yasavul, MD,** and Cetin Turgan, MD†† Objective: High body mass index (BMI) is associated with mortality in the general population, whereas obesity is suggested to confer a survival advantage in hemodialysis (HD) patients. However, underlying mechanisms are yet to be elucidated. We examined the cross-sectional association of BMI with inflammatory and nutritional markers and atherosclerosis in HD patients. Design: Cross-sectional study. Setting and participants: One hundred and nine maintenance HD patients in the Hacettepe University Hospital Haemodialysis Unit were studied. Methods: Data on demographics, comorbidity, and anthropometry were obtained by patient interviews. Atherosclerosis was assessed by B-mode Doppler ultrasonography on common carotid artery. Serum markers of inflammation, nutrition, and lipid metabolism, including C-reactive protein (CRP), albumin, prealbumin, homocys- teine and lipoproteins, were measured by standard methods. Main outcome measure: Distribution of inflammatory and nutritional markers and prevalence of atherosclerosis in underweight, normal, overweight, and obese HD patients. Results: CRP levels were significantly higher in obese and underweight HD patients compared with normal and overweight patients (P  .05). The prevalence of atherosclerosis was significantly higher in underweight and obese patients (54.5% and 50%) compared with normal and overweight patients (25.7% and 33%) (P  .05). Conclusions: In the present study, obesity is associated with inflammation and atherosclerosis. An obesity- related survival advantage should be modified by other factors such as race, comorbid conditions, body composition, and nutritional status. © 2005 by the National Kidney Foundation, Inc. C ARDIOVASCULAR DISEASE is the leading cause of death in patients undergo- ing maintenance hemodialysis (HD) and accounts for nearly half of deaths. HD patients have a tenfold increased risk of cardiovascular death compared with the general population, adjusted for age, gender, race, and diabetes. 1 Several re- cent studies suggest that factors associated with greater cardiovascular mortality in the general population may show a paradoxical relationship in patients on HD therapy. 2–5 Therefore, under- standing the risk factors and mechanisms for car- *Fellow of Nephrology, Hacettepe University Faculty of Medicine, Department of Nephrology, Ankara, Turkey. †Fellow of Nephrology, Hacettepe University Faculty of Medicine, Department of Nephrology, Ankara, Turkey. ‡Fellow of Radiology, Hacettepe University Faculty of Medicine, Department of Radiology, Ankara, Turkey. §Associate Professor of Nephrology, Hacettepe University Faculty of Medicine, Department of Nephrology, Ankara, Turkey. Associate Professor of Nephrology, Hacettepe University Faculty of Medicine, Department of Nephrology, Ankara, Turkey. ¶Professor of Nephrology, Hacettepe University Faculty of Medicine, Department of Nephrology, Ankara, Turkey. **Professor of Nephrology, Hacettepe University Faculty of Medicine, Department of Nephrology, Ankara, Turkey. ††Professor of Nephrology, Hacettepe University Faculty of Medicine, Department of Nephrology, Ankara, Turkey. Address reprint requests to Serkan Kahraman, MD, Hacettepe Hastanesi, Nefroloji Bolumu, 06100 Sihhiye, Ankara, Turkey. E-mail: drserkan@hacettepe.edu.tr © 2005 by the National Kidney Foundation, Inc. 1051-2276/05/1504-0004$30.00/0 doi:10.1053/j.jrn.2005.07.004 Journal of Renal Nutrition, Vol 15, No 4 (October), 2005: pp 377-386 377