The prevalence of obesity in patients on peritoneal dialysis was associated with a greater risk for peritonitis requiring hospitalization, according to research published in the American Journal of Kidney Diseases.
While mortality has decreased more rapidly in the peritoneal dialysis (PD) population than in the hemodialysis (HD) population in the United States, “the association between obesity and clinical outcomes among patients with end-stage kidney disease remains unclear in the current era,” Yoshitsugu Obi, PhD, from the Harold Simmons Center for Kidney Disease Research and Epidemiology, division of nephrology and hypertension, University of California Irvine School of Medicine, and colleagues wrote.
Obi and colleagues reviewed the records of 15,573 incident patients on PD using data from a large U.S. dialysis organization between 2007 to 2011. Researchers tabulated BMI alongside length of time on PD, residual renal creatinine clearance, the occurrence of peritonitis and patient survival.
The analysis showed patients on PD who had a higher BMI were significantly associated
with shorter time to transfer to HD therapy, longer time to kidney transplantation and, “with borderline significance, more frequent peritonitis-related hospitalization,” the authors wrote.
When comparing obese patients with PD to leaner patients, “obese patients had faster declines in residual kidney function (P for trend <0.001) and consistently achieved lower total Kt/V over time (P for trend < 0.001) despite greater increases in dialysis Kt/V (P for trend < 0.001),” the authors wrote. The best survival outcomes were seen among patients with a BMI range of 30 to at least 35 kg/m2 in the case-mix adjusted model.
“Compared with matched HD patients, PD patients had lower mortality in the BMI categories of [less than] 25 and 25 to [at least] 35 kg/m2 and had equivalent survival in the BMI category 35 kg/m2 (P for interaction =0.001 [vs. < 25 kg/m2]). This attenuation in survival difference among patients with severe obesity was observed only in patients with diabetes, but not those without diabetes,” the authors wrote.
Disclosures: The authors have no relevant financial disclosures.