Date of Award
Summer 8-2026
Document Type
Dissertation
Degree Name
Doctor of Philosophy (PhD)
Program/Concentration
Health Services Research
Committee Director
Harry Zhang
Committee Member
Denise McKinney
Committee Member
Maria Díaz-González de Ferris
Abstract
Chronic kidney disease (CKD) remains a significant public health challenge. Literature suggests that CKD and end-stage kidney disease (ESKD) patients with overweight or obesity (based on body mass index) may have a similar or lower mortality than those with normal weight, i.e., the obesity paradox. The present studies investigated the obesity paradox in patients maintained on chronic hemodialysis (HD), while focusing on its relationship with mortality, and cardiovascular (CV) events in both adult and pediatric populations. The rationale was to further clarify the association of body mass in chronic HD patients and reframing the obesity paradox to focus on specific body composition, differentiating between muscle and fat tissue mass. The first study systematically evaluated and synthesized existing evidence on the associations between body mass measures and CV events and mortality in individuals on chronic HD more than 90 days. The second study assessed the associations between BCM and CV events and mortality in a global cohort of adults on chronic HD, with particular emphasis on disentangling the effects of lean tissue mass (LTM) and fat tissue mass (FTM). Lastly, the third study explored the relationship between BCM and CV events and mortality in a global pediatric cohort maintained on HD, discussing the potential early-life contributors to the obesity paradox. The hypothesis was that an association existed between BCM and both CV events and mortality, with muscle mass serving as a risk-reducing factor in higher weight, improving survival, and decreasing CV events. The findings suggest that lean tissue is the driver of the protective effect in adults, while fat tissue is the variable of importance in the critical component of children. The finding and conclusions of these studies contribute to the obesity paradox knowledge and are expected to inform patient-specific interventions that refine clinical guidelines and lead to the enhancement of treatment strategies for patients maintained on HD.
Rights
In Copyright. URI: http://rightsstatements.org/vocab/InC/1.0/ This Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s).
DOI
10.25777/2zk8-sr11
Recommended Citation
Chou, Po-Yi.
"Mass on Cardiovascular Events and Mortality in the 2019 Mondo Hemodialysis Cohort"
(2026). Doctor of Philosophy (PhD), Dissertation, , Old Dominion University, DOI: 10.25777/2zk8-sr11
https://digitalcommons.odu.edu/healthservices_etds/100