Body Mass Index and Mortality Risk in Asian Peritoneal Dialysis Patients in Hong Kong-impact of Diabetes and Cardiovascular Disease Status

Overview

Journal Perit Dial Int

Publisher Sage Publications

Date 2014 Feb 6

PMID 24497598

Citations 13

Authors

Verukonda Ravi Kiran

Tong Ying Zhu

Terence Yip

Sing Leung Lui

Wai Kei Lo

Affiliations

Soon will be listed here.

Abstract

Background: Obesity increases mortality in the general population, but improves survival in hemodialysis patients. In peritoneal dialysis (PD) patients, the reported effect is controversial. We investigated the effect of body mass index (BMI) on patient survival in Asian PD patients.

Methods: The survival of incident Asian PD patients from 2001 to 2008 in a single center in Hong Kong was analyzed retrospectively. Baseline demographic and clinical data were collected from patient records. Patients who had a total Kt/V below 1.7 or who died within 6 months were excluded. The BMI was categorized using the World Health Organization recommendation for Asian populations.

Results: In the 274 study patients [154 men (56%); 138 with diabetes (50.4%); mean age: 63.4 ± 14.6 years; mean BMI: 21.97 ± 3.23 kg/m(2); 37 underweight (13.5%); 35 obese (12.8%)], the relative risk (RR) for mortality [adjusted for age, diabetes status, and cardiovascular disease (CVD)] was similar for the normal and overweight groups, but higher for the underweight (RR: 1.909; p = 0.028) and obese groups (RR: 1.799; p = 0.048). The increased mortality in obese patients was more prominent in patients with diabetes (RR: 1.9 vs 1.19 in patients without diabetes; p = 0.074 and 0.76 respectively), and in patients with CVD (RR: 8.895 vs 1.642 in patients without CVD; p = 0.012 and 0.122 respectively).

Conclusions: In Asian PD patients, the relationship between BMI and mortality was U-shaped, with higher mortality in the underweight and obese patients. The negative impact of obesity was more prominent in patients with diabetes and CVD.

Citing Articles

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References

Snyder J, Foley R, Gilbertson D, Vonesh E, Collins A . Body size and outcomes on peritoneal dialysis in the United States. Kidney Int. 2003; 64(5):1838-44. DOI: 10.1046/j.1523-1755.2003.00287.x. View

Johnson D, Herzig K, Purdie D, Chang W, Brown A, Rigby R . Is obesity a favorable prognostic factor in peritoneal dialysis patients?. Perit Dial Int. 2001; 20(6):715-21. View

Leavey S, Strawderman R, Jones C, Port F, Held P . Simple nutritional indicators as independent predictors of mortality in hemodialysis patients. Am J Kidney Dis. 1998; 31(6):997-1006. DOI: 10.1053/ajkd.1998.v31.pm9631845. View

Calle E, Thun M, Petrelli J, Rodriguez C, Heath Jr C . Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med. 1999; 341(15):1097-105. DOI: 10.1056/NEJM199910073411501. View

McDonald S, Collins J, Johnson D . Obesity is associated with worse peritoneal dialysis outcomes in the Australia and New Zealand patient populations. J Am Soc Nephrol. 2003; 14(11):2894-901. DOI: 10.1097/01.asn.0000091587.55159.5f. View

Degoulet P, LEGRAIN M, Reach I, Aime F, deVries C, Rojas P . Mortality risk factors in patients treated by chronic hemodialysis. Report of the Diaphane collaborative study. Nephron. 1982; 31(2):103-10. DOI: 10.1159/000182627. View

Byers T . Body weight and mortality. N Engl J Med. 1995; 333(11):723-4. DOI: 10.1056/NEJM199509143331109. View

Lew E, GARFINKEL L . Variations in mortality by weight among 750,000 men and women. J Chronic Dis. 1979; 32(8):563-76. DOI: 10.1016/0021-9681(79)90119-x. View

Huang C, Tighiouart H, Beddhu S, Cheung A, Dwyer J, Eknoyan G . Both low muscle mass and low fat are associated with higher all-cause mortality in hemodialysis patients. Kidney Int. 2010; 77(7):624-9. PMC: 3155769. DOI: 10.1038/ki.2009.524. View

10.

. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004; 363(9403):157-63. DOI: 10.1016/S0140-6736(03)15268-3. View

11.

Aslam N, Bernardini J, Fried L, Piraino B . Large body mass index does not predict short-term survival in peritoneal dialysis patients. Perit Dial Int. 2002; 22(2):191-6. View

12.

Dorn J, Schisterman E, Winkelstein Jr W, Trevisan M . Body mass index and mortality in a general population sample of men and women. The Buffalo Health Study. Am J Epidemiol. 1997; 146(11):919-31. DOI: 10.1093/oxfordjournals.aje.a009218. View

13.

Noori N, Kopple J, Kovesdy C, Feroze U, Sim J, Murali S . Mid-arm muscle circumference and quality of life and survival in maintenance hemodialysis patients. Clin J Am Soc Nephrol. 2010; 5(12):2258-68. PMC: 2994088. DOI: 10.2215/CJN.02080310. View

14.

Pliakogiannis T, Trpeski L, Taskapan H, Shah H, Ahmad M, Fenton S . Reverse epidemiology in peritoneal dialysis patients: the Canadian experience and review of the literature. Int Urol Nephrol. 2006; 39(1):281-8. DOI: 10.1007/s11255-006-9142-1. View

15.

Abbott K, Glanton C, Trespalacios F, Oliver D, Ortiz M, Agodoa L . Body mass index, dialysis modality, and survival: analysis of the United States Renal Data System Dialysis Morbidity and Mortality Wave II Study. Kidney Int. 2004; 65(2):597-605. DOI: 10.1111/j.1523-1755.2004.00385.x. View

16.

de Mutsert R, Grootendorst D, Boeschoten E, Dekker F, Krediet R . Is obesity associated with a survival advantage in patients starting peritoneal dialysis?. Contrib Nephrol. 2009; 163:124-131. DOI: 10.1159/000223790. View

17.

Wong J, Port F, Carroll C, Wolfe R, Agodoa L, Daugirdas J . Survival advantage in Asian American end-stage renal disease patients. Kidney Int. 1999; 55(6):2515-23. DOI: 10.1046/j.1523-1755.1999.00464.x. View

18.

Kalantar-Zadeh K, Abbott K, Salahudeen A, Kilpatrick R, Horwich T . Survival advantages of obesity in dialysis patients. Am J Clin Nutr. 2005; 81(3):543-54. DOI: 10.1093/ajcn/81.3.543. View

19.

Lo W, Bargman J, Burkart J, Krediet R, Pollock C, Kawanishi H . Guideline on targets for solute and fluid removal in adult patients on chronic peritoneal dialysis. Perit Dial Int. 2006; 26(5):520-2. View

20.

Hoogeveen E, Halbesma N, Rothman K, Stijnen T, van Dijk S, Dekker F . Obesity and mortality risk among younger dialysis patients. Clin J Am Soc Nephrol. 2012; 7(2):280-8. PMC: 3280032. DOI: 10.2215/CJN.05700611. View