{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T16:03:41Z","timestamp":1780416221523,"version":"3.54.1"},"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T00:00:00Z","timestamp":1745366400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["NRF-2021R1F1A1050858"],"award-info":[{"award-number":["NRF-2021R1F1A1050858"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Korea Fund for Regenerative Medicine","award":["22C0701L1"],"award-info":[{"award-number":["22C0701L1"]}]},{"name":"Clinical Research Institute grant of The Catholic University of Korea","award":["CMCDJ-P-2019-016"],"award-info":[{"award-number":["CMCDJ-P-2019-016"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Obesity and adipose tissue are commonly regarded as detrimental factors linked to adverse outcomes, including cardiovascular and metabolic diseases. However, the obesity paradox is obesity that may provide survival benefits for chronic diseases including patients undergoing hemodialysis. Fat mass can be a surrogate marker for nutrition status in patients undergoing hemodialysis. Thus, this study evaluated subcutaneous fat and all-cause mortality in patients initiating hemodialysis. A total of 123 patients initiating hemodialysis were included in this study. MATLAB (version R2014a) was used to identify subcutaneous fat area (SFA) and visceral fat area (VFA) in computed tomography images for the analysis of body composition. The survival rate was calculated using Cox regression analysis. The Kaplan\u2013Meier survival rates were 70.0% and 85.7% in the low and high subcutaneous fat area (SFA) groups, respectively (log rank, p = 0.021). In Cox analysis, the low SFA group showed high risk for all-cause mortality than the high SFA group (hazard ratio (HR) 3.541, 95% CI 1.358\u20139.235, p = 0.010). In subgroup univariate analysis, the risk for all-cause mortality was higher in patients with low SFA and diabetes than those with high SFA and diabetes (HR 3.541, 95% CI 1.358\u20139.235, p = 0.010). In multivariate analysis, the risk for all-cause mortality was higher in patients with low SFA and diabetes than those with high SFA and diabetes (HR 4.615, 95% CI 1.484\u201314.351, p = 0.008). Conclusively, low SFA increases the risk of 2-year all-cause mortality, and SFA analysis can provide information for risk evaluation for patients initiating hemodialysis.<\/jats:p>","DOI":"10.1371\/journal.pone.0304486","type":"journal-article","created":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T17:27:40Z","timestamp":1745429260000},"page":"e0304486","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Abdominal subcutaneous fat area can predict 2-year survival in patients with end-stage renal disease initiating hemodialysis"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8953-1059","authenticated-orcid":true,"given":"Wonjung","family":"Choi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyerim","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hwajin","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4193-2034","authenticated-orcid":true,"given":"Yoon-kyung","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2870-3958","authenticated-orcid":true,"given":"Dae Eun","family":"Choi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,4,23]]},"reference":[{"issue":"2","key":"pone.0304486.ref001","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.ekir.2017.01.009","article-title":"The obesity paradox in kidney disease: how to reconcile it with obesity management","volume":"2","author":"K Kalantar-Zadeh","year":"2017","journal-title":"Kidney Int Rep"},{"issue":"4","key":"pone.0304486.ref002","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1016\/j.pcad.2013.10.005","article-title":"Obesity paradox in end-stage kidney disease patients","volume":"56","author":"J Park","year":"2014","journal-title":"Prog Cardiovasc Dis"},{"issue":"3","key":"pone.0304486.ref003","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1038\/sj.ki.5000331","article-title":"Body fat mass and lean mass as predictors of survival in hemodialysis patients","volume":"70","author":"R Kakiya","year":"2006","journal-title":"Kidney Int"},{"issue":"3","key":"pone.0304486.ref004","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1016\/j.metabol.2004.09.012","article-title":"Altered relationship between body fat and plasma adiponectin in end-stage renal disease","volume":"54","author":"T Shoji","year":"2005","journal-title":"Metabolism"},{"issue":"6","key":"pone.0304486.ref005","doi-asserted-by":"crossref","first-page":"1895","DOI":"10.3390\/nu13061895","article-title":"Significance of adipose tissue maintenance in patients undergoing hemodialysis","volume":"13","author":"S Okuno","year":"2021","journal-title":"Nutrients"},{"issue":"4","key":"pone.0304486.ref006","doi-asserted-by":"crossref","first-page":"480","DOI":"10.3390\/nu10040480","article-title":"The impact of abdominal fat levels on all-cause mortality risk in patients undergoing hemodialysis","volume":"10","author":"T Yajima","year":"2018","journal-title":"Nutrients"},{"issue":"4","key":"pone.0304486.ref007","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1053\/j.ajkd.2015.09.028","article-title":"Misclassification of obesity by body mass index among patients receiving hemodialysis","volume":"67","author":"P Kittiskulnam","year":"2016","journal-title":"Am J Kidney Dis"},{"issue":"1","key":"pone.0304486.ref008","doi-asserted-by":"crossref","first-page":"147","DOI":"10.3390\/nu13010147","article-title":"Uremic sarcopenia and its possible nutritional approach","volume":"13","author":"A Noce","year":"2021","journal-title":"Nutrients"},{"key":"pone.0304486.ref009","doi-asserted-by":"crossref","first-page":"111238","DOI":"10.1016\/j.nut.2021.111238","article-title":"Edema in critically ill patients leads to overestimation of skeletal muscle mass measurements using computed tomography scans","volume":"89","author":"MR Baggerman","year":"2021","journal-title":"Nutrition"},{"issue":"4","key":"pone.0304486.ref010","doi-asserted-by":"crossref","first-page":"367","DOI":"10.2174\/1573399810602040367","article-title":"Metabolic obesity: the paradox between visceral and subcutaneous fat","volume":"2","author":"O Hamdy","year":"2006","journal-title":"Curr Diabetes Rev"},{"issue":"11","key":"pone.0304486.ref011","doi-asserted-by":"crossref","first-page":"E1756-60","DOI":"10.1210\/jc.2011-0615","article-title":"Preferential fat deposition in subcutaneous versus visceral depots is associated with insulin sensitivity","volume":"96","author":"T McLaughlin","year":"2011","journal-title":"J Clin Endocrinol Metab"},{"issue":"12","key":"pone.0304486.ref012","doi-asserted-by":"crossref","first-page":"1626","DOI":"10.1161\/01.CIR.0000057974.74060.68","article-title":"Peripheral adiposity exhibits an independent dominant antiatherogenic effect in elderly women","volume":"107","author":"LB Tank\u00f3","year":"2003","journal-title":"Circulation"},{"issue":"7","key":"pone.0304486.ref013","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1038\/ki.2009.524","article-title":"Both low muscle mass and low fat are associated with higher all-cause mortality in hemodialysis patients","volume":"77","author":"CX Huang","year":"2010","journal-title":"Kidney Int"},{"issue":"22","key":"pone.0304486.ref014","doi-asserted-by":"crossref","first-page":"e15867","DOI":"10.1097\/MD.0000000000015867","article-title":"Semiautomatic software for measurement of abdominal muscle and adipose areas using computed tomography: a STROBE-compliant article","volume":"98","author":"SS Kim","year":"2019","journal-title":"Medicine (Baltimore)"},{"issue":"11","key":"pone.0304486.ref015","doi-asserted-by":"crossref","first-page":"2317","DOI":"10.3390\/nu14112317","article-title":"Prognostic value of the controlling nutritional status (CONUT) score in patients at dialysis initiation","volume":"14","author":"K Takagi","year":"2022","journal-title":"Nutrients"},{"issue":"5","key":"pone.0304486.ref016","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1053\/j.jrn.2021.09.005","article-title":"Predictive value of objective nutritional indexes in technique failure in peritoneal dialysis patients","volume":"32","author":"Y Yang","year":"2022","journal-title":"J Ren Nutr"},{"issue":"1","key":"pone.0304486.ref017","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1186\/s12933-018-0734-8","article-title":"Abdominal subcutaneous adipose tissue: a favorable adipose depot for diabetes?","volume":"17","author":"P Chen","year":"2018","journal-title":"Cardiovasc Diabetol"},{"issue":"11","key":"pone.0304486.ref018","doi-asserted-by":"crossref","first-page":"1234","DOI":"10.1161\/CIRCULATIONAHA.107.710509","article-title":"Visceral and subcutaneous adipose tissue volumes are cross-sectionally related to markers of inflammation and oxidative stress: the Framingham Heart Study","volume":"116","author":"KM Pou","year":"2007","journal-title":"Circulation"},{"issue":"2","key":"pone.0304486.ref019","doi-asserted-by":"crossref","first-page":"e0211988","DOI":"10.1371\/journal.pone.0211988","article-title":"The associations of fat tissue and muscle mass indices with all-cause mortality in patients undergoing hemodialysis","volume":"14","author":"T Yajima","year":"2019","journal-title":"PLoS One"},{"key":"pone.0304486.ref020","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.cca.2007.01.026","article-title":"Adiponectin as an anti-inflammatory factor","volume":"380","author":"N Ouchi","year":"2007","journal-title":"Clin Chim Acta"},{"issue":"12","key":"pone.0304486.ref021","doi-asserted-by":"crossref","first-page":"1363","DOI":"10.1038\/ijo.2009.184","article-title":"Body mass index as a phenotypic expression of adiposity: quantitative contribution of muscularity in a population-based sample","volume":"33","author":"SB Heymsfield","year":"2009","journal-title":"Int J Obes (Lond)"},{"issue":"1","key":"pone.0304486.ref022","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1186\/s12882-020-02003-4","article-title":"Protein energy-wasting associated with nephrotic syndrome - the comparison of metabolic pattern in severe nephrosis to different stages of chronic kidney disease","volume":"21","author":"A Matyjek","year":"2020","journal-title":"BMC Nephrol"},{"issue":"8","key":"pone.0304486.ref023","doi-asserted-by":"crossref","first-page":"e0183281","DOI":"10.1371\/journal.pone.0183281","article-title":"Extracellular overhydration linked with endothelial dysfunction in the context of inflammation in haemodialysis dependent chronic kidney disease","volume":"12","author":"N Mitsides","year":"2017","journal-title":"PLoS One"},{"issue":"1","key":"pone.0304486.ref024","doi-asserted-by":"crossref","first-page":"4441","DOI":"10.1038\/s41598-018-21226-y","article-title":"Bioimpedance-defined overhydration predicts survival in end stage kidney failure (ESKF): systematic review and subgroup meta-analysis","volume":"8","author":"M Tabinor","year":"2018","journal-title":"Sci Rep"},{"issue":"4","key":"pone.0304486.ref025","doi-asserted-by":"crossref","first-page":"e0250467","DOI":"10.1371\/journal.pone.0250467","article-title":"A novel approach to dry weight adjustments for dialysis patients using machine learning","volume":"16","author":"HR Kim","year":"2021","journal-title":"PLoS One"},{"issue":"9","key":"pone.0304486.ref026","doi-asserted-by":"crossref","first-page":"2329","DOI":"10.1097\/01.ASN.0000081662.64171.9B","article-title":"Different impact of biomarkers as mortality predictors among diabetic and nondiabetic patients undergoing hemodialysis","volume":"14","author":"B Hocher","year":"2003","journal-title":"J Am Soc Nephrol"},{"issue":"11","key":"pone.0304486.ref027","doi-asserted-by":"crossref","first-page":"2890","DOI":"10.1007\/s00125-011-2259-5","article-title":"Transplantation of non-visceral fat to the visceral cavity improves glucose tolerance in mice: investigation of hepatic lipids and insulin sensitivity","volume":"54","author":"MT Foster","year":"2011","journal-title":"Diabetologia"},{"issue":"6","key":"pone.0304486.ref028","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1097\/MOL.0b013e32832ec396","article-title":"Relationship between LDL, HDL, blood pressure and atheroma progression in the coronaries","volume":"20","author":"SJ Nicholls","year":"2009","journal-title":"Curr Opin Lipidol"},{"issue":"8","key":"pone.0304486.ref029","doi-asserted-by":"crossref","first-page":"1216","DOI":"10.1089\/ars.2013.5537","article-title":"Low-density lipoprotein-cholesterol-induced endothelial dysfunction and oxidative stress: the role of statins","volume":"20","author":"N Hermida","year":"2014","journal-title":"Antioxid Redox Signal"},{"issue":"6","key":"pone.0304486.ref030","doi-asserted-by":"crossref","first-page":"e0286670","DOI":"10.1371\/journal.pone.0286670","article-title":"Trends and outcome of statin therapy in dialysis patients with atherosclerotic cardiovascular diseases: a population-based cohort study","volume":"18","author":"M Lee","year":"2023","journal-title":"PLoS One"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0304486","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T17:27:50Z","timestamp":1745429270000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0304486"}},"subtitle":[],"editor":[{"given":"Yuchen","family":"Qiu,","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,4,23]]},"references-count":30,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4,23]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0304486","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,23]]}}}