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The effect of body mass index on mortality, peritonitis, technique proficiency and residual renal function in peritoneal dialysis patients

  • Nephrology - Original Paper
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Abstract

Background

The prevalence of obesity is increasing worldwide. Obesity is also increasing in the chronic kidney disease (CKD) population. There are conflicting data on complications such as mortality, peritonitis, and technique proficiency of peritoneal dialysis (PD) in underweight and obese patients according to body mass index (BMI). We aimed to present the data in our region to the literature by comparing the residual renal function (RRF), peritonitis, technique proficiency, and mortality rates of the patients we grouped according to BMI.

Methods

The data of 404 patients who were started and followed up in our clinic between March 2005 and November 2021 were evaluated retrospectively. They were grouped as underweight, normal weight, overweight, and obese according to BMI. RRF, mortality, technique proficiency and peritonitis data of the groups were compared.

Results

Of the 404 patients, 44 were underweight, 199 were normal weight, 110 were overweight, and 55 were obese. No difference was found between the groups in the technique survey and in the time to first peritonitis with Kaplan–Meier analysis (respectively; p = 0.610, p = 0.445). Multivariate Cox regression analysis showed that BMI did not affect mortality (HR 1.196 [95% CI 0.722–1.981] (p = 0.488)).

Conclusion

In conclusion, we report that BMI has no effect on RRF, peritonitis, technique proficiency, and mortality in patients undergoing PD, and that mortality may depend on additional factors such as mean albumin, time to first peritonitis, and loss of RRF.

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Data availability

The dataset used in the current study is available from the corresponding author on reasonable request.

References

  1. Friedman AN (2013) Obesity in patients undergoing dialysis and kidney transplantation. Adv Chronic Kidney Dis 20:128–134

    Article  PubMed  Google Scholar 

  2. Balkau B, Charles MA (1999) Comment on the provisional report from the WHO consultation. European Group for the study of Insulin Resistance (EGIR). Diabet Med 16:442–443

    Article  CAS  PubMed  Google Scholar 

  3. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (2001) Executive summary of the third report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 285:e2486–e2489

    Article  Google Scholar 

  4. McDonald SP, Collins JF, Johnson DW (2003) Obesity Is associated with worse peritoneal dialysis outcomes in the Australia and New Zealand patient populations. J Am Soc Nephrol 14(11):2894–2901

    Article  PubMed  Google Scholar 

  5. Mehrotra R, Chiu YW, Kalantar-Zadeh K, Vonesh E (2009) The outcomes of continuous ambulatory and automated peritoneal dialysis are similar. Kidney Int 76(1):97–107

    Article  PubMed  Google Scholar 

  6. Ladhani M, Craig JC, Irving M, Clayton PA, Wong G (2017) Obesity and the risk of cardiovascular and all-cause mortality in chronic kidney disease: a systematic review and meta-analysis. Nephrol Dial Transplant 32(3):439–449

    CAS  PubMed  Google Scholar 

  7. Leavey SF, McCullough K, Hecking E, Goodkin D, Port FK, Young EW (2001) Body mass index and mortality in healthier as compared with sicker haemodialysis patients: results from the Dialysis Outcomes and Practice and Patterns Study (DOPPS). Nephrol Dial Transplant 16:2386–2394

    Article  CAS  PubMed  Google Scholar 

  8. Kalantar-Zadeh K, Block G, Hymphreys MH, Kopple JD (2003) Reverse epidemiology of cardiovascular risk factors in maintenance dialysis patients. Kidney Int 63:793–808

    Article  PubMed  Google Scholar 

  9. Leavey SF, Strawderman RL, Jones CA, Port FK, Held PJ (1998) Simple nutritional indicators as independent predictors of mortality in hemodialysis patients. Am J Kidney Dis 31:997–1006

    Article  CAS  PubMed  Google Scholar 

  10. Fleischmann E, Teal N, Dudley J, May W, Bower JD, Salahudeen AK (1999) Influence of excess weight on mortality and hospital stay in 1346 hemodialysis patients. Kidney Int 55:1560–15667

    Article  CAS  PubMed  Google Scholar 

  11. Kopple JD, Zhu Z, Lew NL, Lowrie EG (1999) Body weight-for-height relationships predict mortality in maintenance hemodialysis patients. Kidney Int 56:1136–1148

    Article  CAS  PubMed  Google Scholar 

  12. Snyder JJF, Gilbertson DT, Vonesh EF, Collins AJ (2003) Body size and outcomes on peritoneal dialysis in the United States. Kidney Int 64(5):1838–1844

    Article  PubMed  Google Scholar 

  13. Prasad N, Sinha A, Gupta A et al (2014) Effect of body mass index on outcomes of peritoneal dialysis patients in India. Perit Dial Int 34(4):399–408

    Article  PubMed  PubMed Central  Google Scholar 

  14. Pavey BS, Whaley-Connell A, Nichols WK, Negoi D, Khanna R (2008) A series of unusual complications of the presternal peritoneal dialysis catheter. Adv Perit Dial 24:113–116

    PubMed  Google Scholar 

  15. Cho Y, Johnson W (2014) Peritoneal dialysis-related peritonitis: towards improving evidence, practices, and outcomes. Am J Kidney Dis 64(2):278–289

    Article  PubMed  Google Scholar 

  16. Kalantar-Zadeh K, Abott KC, Slahudeen AK, Kilpatrick RD, Horwich TB (2005) Survival advantages of obesity in dialysis patients. Am J Clin Nutr 81:e543–e554

    Article  Google Scholar 

  17. Ahmadi SF, Zahmatkesh G, Streja E, Mehrotra R, Rhee CM, Kovesdyl CP et al (2015) Association of body mass index with mortality in peritoneal dialysis patients: a systematic review and meta-analysis. Perit Dial Int 36:315–325

    Article  PubMed  Google Scholar 

  18. Zhou H, Cui L, Zhu G, Jiang Y, Gao X, Yl Z et al (2011) Survival advantage of normal weight in peritoneal dialysis patients. Ren Fail 33:e964–e968

    Article  Google Scholar 

  19. Lo WK (2016) Metabolic syndrome and obesity in peritoneal dialysis. Kidney Res Clin Pract 35:10–14

    Article  PubMed  PubMed Central  Google Scholar 

  20. Fernandes NM, Bastos MG, Franco MR, Chaoubah A, Lima Mda G, Divino-Filho JC, Qureshi AR (2013) Brazilian Peritoneal Dialysis Multicenter Study (BRAZPD) Group: body size and longitudinal body weight changes do not increase mortality in incident peritoneal dialysis patients of the Brazilian peritoneal dialysis multicenter study. Clinics 68:51–58

    Article  PubMed  Google Scholar 

  21. Ramkumar N, Pappas LM, Beddhu S (2005) Effect of body size and body composition on survival in peritoneal dialysis patients. Perit Dial Int 25(5):461–469

    Article  PubMed  Google Scholar 

  22. Chan GC, Fung WW, Szeto CC, Ng JK (2023) From MIA to FIFA: the vicious matrix of frailty, inflammation, fluid overload and atherosclerosis in peritoneal dialysis. Nephrology (Carlton) 28(4):215–226

    Article  CAS  PubMed  Google Scholar 

  23. Aslam N, Bernardini J, Fried L, Piraino B (2002) Large body mass index does not predict short-term survival in peritoneal dialysis patients. Perit Dial Int 22:191–196

    Article  PubMed  Google Scholar 

  24. Fried L, Bernardini J, Piraino B (1996) Neither size nor weight predicts survival in peritoneal dialysis patients. Perit Dial Int 16:357–361

    Article  CAS  PubMed  Google Scholar 

  25. Shetty A (2011) Logistics of peritoneal dialysis in the obese population. Dial Transplant 40(8):364–366

    Article  ADS  Google Scholar 

  26. Nolph KD, Jensen RA, Khanna R, Twardowski ZJ (1994) Weight limitations for weekly urea clearances using various exchange volumes in continuous ambulatory peritoneal dialysis. Perit Dial Int J Int Soc Perit Dial 14:261–264

    Article  CAS  Google Scholar 

  27. National Kidney Foundation (1997) NKF-DOQI clinical practice guidelines for peritonealdialysis adequacy. Am J Kidney Dis 30:S67-136

    Article  Google Scholar 

  28. Krezalek MA, Bonamici N, Kuchta K, Lapin B, Carbray J (2018) Denham W et all Peritoneal dialysis catheter function and survival are not adversely affected by obesity regardless of the operative technique used. Surg Endosc 32:1714–1723

    Article  PubMed  Google Scholar 

  29. Hsieh Y-P, Chang C-C, Wen Y-K, Chiu P-F (2014) Yang Y (2014) Predictors of peritonitis and the impact of peritonitis on clinical outcomes of continuous ambulatory peritoneal dialysis patients in Taiwan–10 years’ experience in a single center. Perit Dial Int J Int Soc Perit Dial 34:85–94

    Article  CAS  Google Scholar 

  30. Quero M, Comas J, Arcos E, Hueso M, Sandoval D, Montero N (2021) Impact of obesity on the evolution of outcomes in peritoneal dialysis patients. Clin Kidney J 14(3):969–982

    Article  CAS  PubMed  Google Scholar 

  31. Jin Yu, Zhu L, Ni J, Tong M, Wang H (2023) Technique failure in peritoneal dialysis-related peritonitis: risk factors and patient survival. Ren Fail 45:1

    Google Scholar 

  32. Liu D, Lin Y, Gong N, Xiao Z, Zhang F, Zhong X, Ai J (2021) Degree and duration of hypokalemia associated with peritonitis in patients undergoing peritoneal dialysis. Int J Clin Pract 75(8):e14188

    Article  CAS  PubMed  Google Scholar 

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Funding

Funding was not received for this study.

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Authors and Affiliations

  1. Department of Nephrology, Faculty of Medicine, Atatürk University, 25240, Erzurum, Turkey

    Murat Altunok, Erdem Çankaya, Hatice Gözübüyük Kaplan, Enes Çınar, Abdullah Uyanık & Can Sevinç

Authors
  1. Murat Altunok
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  2. Erdem Çankaya
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  3. Hatice Gözübüyük Kaplan
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  4. Enes Çınar
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  5. Abdullah Uyanık
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  6. Can Sevinç
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Contributions

MA, EÇ: conceptualization, methodology, software. MA, EÇ, HGK, EÇ: data curation, writing—original draft preparation. MA, AU, CS, HGK, EÇ: patient and specimen collection. MA, EÇ: laboratory studies. MA, EÇ, AU: visualization, investigation. MA, EÇ: writing—reviewing and editing.

Corresponding author

Correspondence to Murat Altunok.

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Conflict of interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical approval

All participants gave informed consent and the local institutional ethics committee (Ataturk University School of Medicine Clinical Research Ethics Committee) approved the study methods (Acceptance number: B.30.2.ATA.0.01.00/133) ‘Declarations Section’—‘Ethics approval and consent to participate’ sub-section.

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Altunok, M., Çankaya, E., Gözübüyük Kaplan, H. et al. The effect of body mass index on mortality, peritonitis, technique proficiency and residual renal function in peritoneal dialysis patients. Int Urol Nephrol (2024). https://doi.org/10.1007/s11255-024-03988-9

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