The Obesity Paradox Reconsidered: Evidence from a Multicenter Romanian Hemodialysis Cohort.

Although left ventricular hypertrophy approached significance and left ventricular ejection fraction was preserved across BMI strata, the higher prevalence of atherosclerotic disease in higher BMI categories aligns with known metabolic and hemodynamic consequences of adiposity.

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Regarding cardiac function, preserved LVEF (≥50%) was independently associated with better survival (HR 0.665, 95% CI 0.482–0.918, p = 0.013), while mildly reduced LVEF (41–49%) did not reach statistical significance after adjustment.

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The prevalence of obesity is higher in CKD as compared to the general population (at least in the USA), and it presents an increasing trend all over the CKD spectrum (including predialysis, hemodialysis, and kidney transplantation) [ 4 ].

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