{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T18:22:56Z","timestamp":1776795776256,"version":"3.51.2"},"reference-count":45,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Chongqing Science and Health Joint Medical Research Top Project","award":["2025MSXM108"],"award-info":[{"award-number":["2025MSXM108"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Body composition parameters (such as BMI and waist-to-hip ratio) have a certain predictive value for blood pressure. In patients undergoing maintenance hemodialysis (MHD), BMI can affect dialysis adequacy and blood pressure control levels, and there are differences in body composition at different BMI levels. The aim of this study was to investigate the association between hypertension during dialysis and body composition in non-overweight\/overweight obese patients. A total of 248 patients undergoing maintenance hemodialysis (MHD) at this center were enrolled. Body composition was measured using an InBody bioelectrical impedance analyzer prior to dialysis. Intra-dialysis blood pressure data from the preceding three months were collected via the hemodialysis system. Patients were categorized based on their dry weight at enrollment: those with BMI\u2009&lt;\u200923\u2009kg\/m\u00b2 were classified as the non-overweight group, and those with BMI\u2009\u2265\u200923\u2009kg\/m\u00b2 as the overweight\/obese group. LASSO regression was employed to identify body composition variables associated with hypertension during hemodialysis. Based on LASSO regression results, multivariate linear regression and logistic regression analyses were conducted to evaluate the impact of pre-dialysis body composition on blood pressure (BP) in non-overweight and overweight\/obese hemodialysis patients. The overall prevalence of hypertension was 86% (214\/248), and the proportion of overweight\/obese patients was 41.0% (102\/248). TBW and Protein were positively correlated with hypertension in non-overweight male patients (OR (95% CI): 1.28 (0.34\u20131.98); OR (95% CI): 1.97 (1.51\u20133.33)), and BMC was negatively associated with hypertension in non-overweight male patients (OR (95% CI): 0.10 (0.01\u20130.70)). In overweight obese female patients, Fat was positively associated with hypertension (OR (95% CI): 1.12 (1.01\u20132.26)). This study identified risk factors for elevated blood pressure associated with gender and BMI in a subset of the MHD Asian population. The study also provided evidence that different body composition factors (such as total body water, protein, bone mineral content, and fat) drive hypertension risk in different MHD subgroups, rather than being determined solely by BMI.<\/jats:p>","DOI":"10.1371\/journal.pone.0333566","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T17:30:26Z","timestamp":1776792626000},"page":"e0333566","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Relationship between hypertension during dialysis and body composition in non-overweight\/overweight obese patients"],"prefix":"10.1371","volume":"21","author":[{"given":"Jiaoyan","family":"Chen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xianqiong","family":"Lu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jurong","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jingrong","family":"Peng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maodi","family":"She","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2513-8619","authenticated-orcid":true,"given":"Yunyan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,4,21]]},"reference":[{"issue":"4","key":"pone.0333566.ref001","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/S0002-9343(03)00366-8","article-title":"Prevalence, treatment, and control of hypertension in chronic hemodialysis patients in the United States","volume":"115","author":"R Agarwal","year":"2003","journal-title":"Am J Med"},{"issue":"4","key":"pone.0333566.ref002","first-page":"505","article-title":"Resistant hypertension in dialysis: epidemiology, diagnosis, and management","volume":"35","author":"PI Georgianos","year":"2024","journal-title":"Kidney International"},{"issue":"3","key":"pone.0333566.ref003","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1007\/s40292-023-00575-4","article-title":"Interdialytic Blood Pressure and Risk of Cardiovascular Events and Death in Hemodialysis Patients","volume":"30","author":"JJG De Lima","year":"2023","journal-title":"High Blood Press Cardiovasc Prev"},{"issue":"6","key":"pone.0333566.ref004","doi-asserted-by":"crossref","DOI":"10.1161\/HYP.0000000000000230","article-title":"Hypertension in Patients Treated With In-Center Maintenance Hemodialysis: Current Evidence and Future Opportunities: A Scientific Statement From the American Heart Association","volume":"80","author":"N Bansal","year":"2023","journal-title":"Hypertension"},{"key":"pone.0333566.ref005","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.phrs.2017.05.013","article-title":"Obesity and hypertension","volume":"122","author":"G Seravalle","year":"2017","journal-title":"Pharmacol Res"},{"issue":"1","key":"pone.0333566.ref006","doi-asserted-by":"crossref","DOI":"10.1152\/ajpendo.00179.2022","article-title":"Obesity and chronic kidney disease","volume":"324","author":"Z Jiang","year":"2023","journal-title":"Am J Physiol Endocrinol Metab"},{"issue":"6","key":"pone.0333566.ref007","doi-asserted-by":"crossref","first-page":"1577","DOI":"10.4103\/1319-2442.352418","article-title":"Associations between Body Mass Index in Hemodialysis Patients and Comorbidity, Dialysis Adequacy, Blood Pressure Control, Vascular Access Type, and Hospital Admission Rate","volume":"32","author":"LM AlSahli","year":"2021","journal-title":"Saudi J Kidney Dis Transpl"},{"issue":"1","key":"pone.0333566.ref008","first-page":"21","article-title":"Body mass index and risk for end-stage renal disease","volume":"144","year":"2006","journal-title":"Am J Kidney Dis"},{"issue":"4","key":"pone.0333566.ref009","doi-asserted-by":"crossref","first-page":"1498","DOI":"10.1046\/j.1523-1755.2001.0590041498.x","article-title":"Obesity-related glomerulopathy: an emerging epidemic","volume":"59","author":"N Kambham","year":"2001","journal-title":"Kidney Int"},{"issue":"3","key":"pone.0333566.ref010","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1007\/s11255-011-9974-1","article-title":"The role of obesity in kidney disease: recent findings and potential mechanisms","volume":"43","author":"RG Kalaitzidis","year":"2011","journal-title":"Int Urol Nephrol"},{"issue":"5","key":"pone.0333566.ref011","doi-asserted-by":"crossref","first-page":"1222","DOI":"10.1093\/ajcn\/80.5.1222","article-title":"Truncal fat mass as a contributor to inflammation in end-stage renal disease","volume":"80","author":"J Axelsson","year":"2004","journal-title":"Am J Clin Nutr"},{"issue":"3","key":"pone.0333566.ref012","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1046\/j.1523-1755.2003.00803.x","article-title":"Reverse epidemiology of cardiovascular risk factors in maintenance dialysis patients","volume":"63","author":"K Kalantar-Zadeh","year":"2003","journal-title":"Kidney Int"},{"issue":"4","key":"pone.0333566.ref013","doi-asserted-by":"crossref","first-page":"546","DOI":"10.3109\/0886022X.2013.876351","article-title":"Obesity, diabetes and survival in maintenance hemodialysis patients","volume":"36","author":"SM Deger","year":"2014","journal-title":"Ren Fail"},{"issue":"9","key":"pone.0333566.ref014","article-title":"Prevalence of Overhydration in Patients on Maintenance Haemodialysis As Determined by Body Composition Monitor and Effects of Attaining Target Dry Weight","volume":"14","author":"NC Mathilakath","year":"2022","journal-title":"Cureus"},{"issue":"11","key":"pone.0333566.ref015","doi-asserted-by":"crossref","first-page":"1993","DOI":"10.1017\/S0007114522002719","article-title":"Body composition and anthropometric indicators as predictors of blood pressure: a cross-sectional study conducted in young Algerian adults","volume":"129","author":"CC Dahel-Mekhancha","year":"2023","journal-title":"Br J Nutr"},{"key":"pone.0333566.ref016","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.ejim.2021.04.025","article-title":"Both lean and fat body mass associate with blood pressure","volume":"91","author":"PE Korhonen","year":"2021","journal-title":"Eur J Intern Med"},{"issue":"1","key":"pone.0333566.ref017","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1159\/000534399","article-title":"Low Lean Tissue Index and Muscle Strength Combined with High Fat Tissue Index Are Associated with Cardiovascular Disease-Related Hospitalisation in Patients on Haemodialysis","volume":"13","author":"M Tian","year":"2023","journal-title":"Cardiorenal Med"},{"issue":"3","key":"pone.0333566.ref018","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1159\/000504245","article-title":"Association of Body Composition and Intradialytic Hypotension in Hemodialysis Patients","volume":"49","author":"M Tian","year":"2020","journal-title":"Blood Purif"},{"issue":"5","key":"pone.0333566.ref019","first-page":"78","article-title":"Body composition and basal metabolic rate in overweight and obese patients","volume":"91","author":"EA Burlyaeva","year":"2022","journal-title":"Vopr Pitan"},{"issue":"1","key":"pone.0333566.ref020","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1161\/01.HYP.0000196279.29758.f4","article-title":"Out-of-hemodialysis-unit blood pressure is a superior determinant of left ventricular hypertrophy","volume":"47","author":"R Agarwal","year":"2006","journal-title":"Hypertension"},{"issue":"3","key":"pone.0333566.ref021","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1161\/HYPERTENSIONAHA.109.144899","article-title":"Blood pressure and mortality among hemodialysis patients","volume":"55","author":"R Agarwal","year":"2010","journal-title":"Hypertension"},{"issue":"1","key":"pone.0333566.ref022","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1681\/ASN.2017020135","article-title":"BP in Dialysis: Results of a Pilot Study","volume":"29","author":"DC Miskulin","year":"2018","journal-title":"J Am Soc Nephrol"},{"issue":"3","key":"pone.0333566.ref023","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1016\/j.kint.2020.10.026","article-title":"Executive summary of the KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease","volume":"99","author":"AK Cheung","year":"2021","journal-title":"Kidney Int"},{"key":"pone.0333566.ref024","volume-title":"Physiology, Body Mass Index","author":"A Zierle-Ghosh","year":"2025"},{"issue":"6","key":"pone.0333566.ref025","doi-asserted-by":"crossref","first-page":"1953","DOI":"10.1007\/s11255-023-03903-8","article-title":"Sodium and water dynamics in the progression of chronic kidney disease: mechanisms and clinical significance","volume":"56","author":"N Spahia","year":"2024","journal-title":"Int Urol Nephrol"},{"issue":"5","key":"pone.0333566.ref026","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1016\/j.kint.2020.01.046","article-title":"Blood pressure and volume management in dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference","volume":"97","author":"JE Flythe","year":"2020","journal-title":"Kidney Int"},{"issue":"5","key":"pone.0333566.ref027","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1053\/j.ajkd.2014.07.003","article-title":"Improving clinical outcomes among hemodialysis patients: a proposal for a \u201cvolume first\u201d approach from the chief medical officers of US dialysis providers","volume":"64","author":"DE Weiner","year":"2014","journal-title":"Am J Kidney Dis"},{"issue":"9","key":"pone.0333566.ref028","doi-asserted-by":"crossref","first-page":"3435","DOI":"10.1093\/ndt\/gfs354","article-title":"Salt intake in kidney disease--a missed therapeutic opportunity?","volume":"27","author":"HJ Lambers Heerspink","year":"2012","journal-title":"Nephrology, Dialysis, Transplantation"},{"issue":"4","key":"pone.0333566.ref029","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1590\/2175-8239-jbn-2019-0135","article-title":"Fluid and hemodynamic management in hemodialysis patients: challenges and opportunities","volume":"41","author":"B Canaud","year":"2019","journal-title":"J Bras Nefrol"},{"issue":"9","key":"pone.0333566.ref030","doi-asserted-by":"crossref","first-page":"1432","DOI":"10.2215\/CJN.01360118","article-title":"Mapping Progress in Reducing Cardiovascular Risk with Kidney Disease: Managing Volume Overload","volume":"13","author":"C Zoccali","year":"2018","journal-title":"Clin J Am Soc Nephrol"},{"issue":"4","key":"pone.0333566.ref031","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1681\/ASN.0000000000000315","article-title":"Resistant Hypertension in Dialysis: Epidemiology, Diagnosis, and Management","volume":"35","author":"PI Georgianos","year":"2024","journal-title":"J Am Soc Nephrol"},{"issue":"6","key":"pone.0333566.ref032","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.1038\/ki.2013.147","article-title":"Prevention and treatment of protein energy wasting in chronic kidney disease patients: a consensus statement by the International Society of Renal Nutrition and Metabolism","volume":"84","author":"TA Ikizler","year":"2013","journal-title":"Kidney Int"},{"key":"pone.0333566.ref033","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1159\/000504240","article-title":"A practical approach to nutrition, protein-energy wasting, sarcopenia, and cachexia in patients with chronic kidney disease","volume":"49","author":"RM Hanna","year":"2020","journal-title":"Blood Purif"},{"issue":"9183","key":"pone.0333566.ref034","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1016\/S0140-6736(99)01437-3","article-title":"High blood pressure and bone-mineral loss in elderly white women: a prospective study","volume":"354","author":"FP Cappuccio","year":"1999","journal-title":"The Lancet"},{"issue":"8","key":"pone.0333566.ref035","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1016\/j.amjhyper.2006.01.017","article-title":"Bone mineral content and blood pressure: What is the pathophysiologic link?","volume":"19","author":"J Titze","year":"2006","journal-title":"Am J Hypertens"},{"issue":"3","key":"pone.0333566.ref036","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1016\/j.amjhyper.2005.10.024","article-title":"Resting blood pressure and bone mineral content are inversely related in overweight and obese Hispanic women","volume":"19","author":"A Afghani","year":"2006","journal-title":"Am J Hypertens"},{"key":"pone.0333566.ref037","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1159\/000478972","article-title":"Association between Extreme Values of Markers of Chronic Kidney Disease: Mineral and Bone Disorder and 5-Year Mortality among Prevalent Hemodialysis Patients","volume":"45","author":"J-G Zhu","year":"2018","journal-title":"Blood Purif"},{"issue":"2","key":"pone.0333566.ref038","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1038\/s41371-018-0107-5","article-title":"Association of body mass index and uncontrolled blood pressure with cardiovascular mortality in peritoneal dialysis patients","volume":"33","author":"W Li","year":"2019","journal-title":"J Hum Hypertens"},{"issue":"2","key":"pone.0333566.ref039","doi-asserted-by":"crossref","DOI":"10.3390\/ijms23020786","article-title":"Metabolic syndrome: updates on pathophysiology and management in 2021","volume":"23","author":"G Fahed","year":"2022","journal-title":"Int J Mol Sci"},{"issue":"1","key":"pone.0333566.ref040","doi-asserted-by":"crossref","first-page":"62","DOI":"10.4103\/1319-2442.279962","article-title":"The relationship between body mass index and blood pressure in patients undergoing chronic hemodialysis: A reverse epidemiology in Jakarta, Indonesia","volume":"31","author":"LA Abdullah Bawazir","year":"2020","journal-title":"Saudi J Kidney Dis Transpl"},{"key":"pone.0333566.ref041","doi-asserted-by":"crossref","DOI":"10.1159\/000345159","article-title":"Relationship between body mass index and mortality in hemodialysis patients: a meta-analysis","volume":"121","author":"W Jialin","year":"2012","journal-title":"Nephron Clin Pract"},{"key":"pone.0333566.ref042","doi-asserted-by":"crossref","first-page":"04087","DOI":"10.7189\/jogh.14.04087","article-title":"Association of risk factors for high blood pressure across 46 low- and middle-income countries: A multi-country cross-sectional analysis","volume":"14","author":"Y Hou","year":"2024","journal-title":"J Glob Health"},{"issue":"4","key":"pone.0333566.ref043","doi-asserted-by":"crossref","first-page":"1068","DOI":"10.1111\/jdi.12999","article-title":"Independent and interactive associations of heart rate and body mass index or blood pressure with type 2 diabetes mellitus incidence: A prospective cohort study","volume":"10","author":"C Xu","year":"2019","journal-title":"J Diabetes Investig"},{"issue":"2","key":"pone.0333566.ref044","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1161\/HYPERTENSIONAHA.119.13058","article-title":"Sex Differences in Blood Pressure Hemodynamics in Middle-Aged Adults With Overweight and Obesity","volume":"74","author":"C Syme","year":"2019","journal-title":"Hypertension"},{"issue":"28","key":"pone.0333566.ref045","doi-asserted-by":"crossref","first-page":"3074","DOI":"10.2174\/138161211798157720","article-title":"Ectopic fat storage, insulin resistance, and hypertension","volume":"17","author":"S Anna Maria","year":"2011","journal-title":"Current Pharmaceutical Design"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0333566","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T17:30:33Z","timestamp":1776792633000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0333566"}},"subtitle":[],"editor":[{"given":"Diego","family":"Moriconi","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,4,21]]},"references-count":45,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4,21]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0333566","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,21]]}}}