Impact of Obesity on Modality Longevity, Residual Kidney Function, Peritonitis, and Survival Among Incident Peritoneal Dialysis Patients

Overview

Journal Am J Kidney Dis

Specialty Nephrology

Date 2017 Dec 11

PMID 29223620

Citations 30

Authors

Yoshitsugu Obi

Elani Streja

Rajnish Mehrotra

Matthew B Rivara

Connie M Rhee

Melissa Soohoo

Daniel L Gillen

Wei-Ling Lau

Csaba P Kovesdy

Kamyar Kalantar-Zadeh

Affiliations

Soon will be listed here.

Abstract

Background: The prevalence of severe obesity, often considered a contraindication to peritoneal dialysis (PD), has increased over time. However, mortality has decreased more rapidly in the PD population than 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.

Study Design: Historical cohort study.

Setting & Participants: 15,573 incident PD patients from a large US dialysis organization (2007-2011).

Predictor: Body mass index (BMI).

Outcomes: Modality longevity, residual renal creatinine clearance, peritonitis, and survival.

Results: Higher BMI was significantly associated with shorter time to transfer to HD therapy (P for trend < 0.001), longer time to kidney transplantation (P for trend < 0.001), and, with borderline significance, more frequent peritonitis-related hospitalization (P for trend = 0.05). Compared with lean 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). There was a U-shaped association between BMI and mortality, with the greatest survival associated with the BMI range of 30 to < 35kg/m in the case-mix adjusted model. Compared with matched HD patients, PD patients had lower mortality in the BMI categories of < 25 and 25 to < 35kg/m and had equivalent survival in the BMI category ≥ 35kg/m (P for interaction = 0.001 [vs < 25 kg/m]). This attenuation in survival difference among patients with severe obesity was observed only in patients with diabetes, but not those without diabetes.

Limitations: Inability to evaluate causal associations. Potential indication bias.

Conclusions: Whereas obese PD patients had higher risk for complications than nonobese PD patients, their survival was no worse than matched HD patients.

Citing Articles

Impact of obesity on in-hospital outcomes in peritoneal dialysis patients: insights from a nationwide analysis.

Kaewput W, Thongprayoon C, Suppadungsuk S, Tangpanithandee S, Wathanavasin W, Qureshi F Int Urol Nephrol. 2025; .

PMID: 40021564 DOI: 10.1007/s11255-025-04438-w.

Risk factors of peritoneal dialysis-related peritonitis in the Japan Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS).

Ito Y, Tu C, Yamaguchi M, Koide S, Ryuzaki M, Bieber B Clin Kidney J. 2024; 17(7):sfae202.

PMID: 39050865 PMC: 11267232. DOI: 10.1093/ckj/sfae202.

Exploring Preconceptions as Barriers to Peritoneal Dialysis Eligibility: A Global Scenario-Based Survey of Kidney Care Physicians.

Shah N, Bennett P, Cho Y, Leibowitz S, Abra G, Kanjanabuch T Kidney Int Rep. 2024; 9(4):941-950.

PMID: 38765569 PMC: 11101779. DOI: 10.1016/j.ekir.2024.01.041.

Machine learning algorithms for the prediction of adverse prognosis in patients undergoing peritoneal dialysis.

Yang J, Wan J, Feng L, Hou S, Yv K, Xu L BMC Med Inform Decis Mak. 2024; 24(1):8.

PMID: 38166909 PMC: 10763100. DOI: 10.1186/s12911-023-02412-z.

The Association Between Serum Vancomycin Level and Clinical Outcome in Patients With Peritoneal Dialysis Associated Peritonitis.

Deacon E, Canney M, McCormick B, Ramsay T, Biyani M, Brown P Kidney Int Rep. 2023; 8(12):2646-2653.

PMID: 38106569 PMC: 10719602. DOI: 10.1016/j.ekir.2023.09.013.

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