J-shaped association between the visceral adiposity index and all-cause mortality in patients with chronic kidney disease

•Controversy remains regarding whether obesity increases the risk for mortality in patients with chronic kidney disease.•Visceral fat deficiency may cause a greater risk for death in the chronic kidney disease population.•Visceral fat deficiency deserves more attention in clinical practice of chronic kidney disease. Visceral obesity, assessed using the visceral adiposity index (VAI), is related to mortality, but studies of populations with chronic kidney disease (CKD) are scarce. The aim of this study was to evaluate the relationship between VAI and all-cause mortality among individuals with CKD. We retrospectively explored the relationship between VAI and risk for all-cause death by analyzing the data of 4145 patients with CKD who participated in the National Health and Nutrition Examination Survey (NHANES) 2001–2006. Patients were followed until December 31, 2015. After an average follow-up of 134.14 mo, 1034 (24.95%) deaths were recorded. Comparison of VAI quartiles with the reference showed an unstable association of VAI with all-cause mortality after adjusting for a wide range of potential confounders in Cox regression analysis. The correlation between VAI and mortality was J-shaped after applying the penalized spline method. Before the inflection point (VAI = 68.23), higher VAI had a protective effect against mortality (hazard ratio [HR], 0.47; 95% confidence interval [CI], 0.28–0.77). However, the risk for all-cause mortality gradually increased with the VAI (HR, 1.13; 95% CI, 1.05–1.21). Visceral obesity may influence the rate of all-cause mortality in a nonlinear manner in populations with CKD. Risk for death was higher with visceral fat deficiency than with excessive visceral fat deposition.