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The Incidence and Pathophysiology of the Obesity Paradox: Should Peritoneal Dialysis and Kidney Transplant Be Offered to Patients with Obesity and End-Stage Renal Disease?

  • Hypertension and Obesity (E Reisin, Section Editor)
  • Published:
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Abstract

Purpose of Review

To educate nephrologists and primary-care physicians about the incidence, pathophysiology, and survival benefits of the obesity paradox in end-stage renal disease (ESRD). This review also discusses the future of kidney transplant and peritoneal dialysis in obese dialysis patients.

Recent Findings

Obesity paradox in ESRD was first reported three decades ago, and since then, there have been several epidemiological studies that confirmed the phenomenon. Regardless of the anthropometric indices used to define obesity in ESRD patients, these markers serve to predict the dialysis patient’s survival. The pathophysiology of obesity paradox tends to be multifactorial. Recent cohort studies demonstrated a survival benefit in all race and ethnic groups, but Hispanics and blacks experienced increased survival rates when compared to non-Hispanic whites. Obese dialysis patients should be offered peritoneal dialysis, especially if they are new to dialysis and have an adequate renal residual function. Several studies have shown that the benefit of receiving kidney transplant in obese patients exceeds the risks. The robotic-assisted kidney transplant (RAKT) procedure is the latest innovation that could offer hope for obese dialysis patients who have been denied or are waiting for kidney transplant.

Summary

The obesity paradox phenomenon in ESRD is a unique illustration of survival benefit in a population that has a high overall annual mortality. Peritoneal dialysis should be encouraged for obese patients who have preserved residual renal function. Kidney transplant centers should encourage RAKT utilization in obese dialysis patients instead of denying them a kidney transplant.

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Acknowledgments

We thank Michelle G. Holt, managing editor, LSU School of medicine, department of medicine for assisting in editing our publication.

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  1. School of Medicine, Department of Medicine, Section of Nephrology and Hypertension, Louisiana State University Health Sciences Center-New Orleans, LSUHSC: 1542 Tulane Ave, New Orleans, LA, 70112, USA

    Ramzi Vareldzis, Mihran Naljayan & Efrain Reisin

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  1. Ramzi Vareldzis
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Vareldzis, R., Naljayan, M. & Reisin, E. The Incidence and Pathophysiology of the Obesity Paradox: Should Peritoneal Dialysis and Kidney Transplant Be Offered to Patients with Obesity and End-Stage Renal Disease?. Curr Hypertens Rep 20, 84 (2018). https://doi.org/10.1007/s11906-018-0882-y

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