Highlights
- •The choice for dialysis modality in an obese diabetic ESRD patient should be individualized.
- •Obesity is not considered to be an absolute contraindication for PD treatment.
- •BMI is not an optimal predictor of outcome in ESRD patients.
Abstract
Obesity is a chronic disease that is increasingly prevalent around the world and is
a well-recognized risk factor for type 2 diabetes and hypertension, leading causes
of end-stage renal disease (ESRD). The obese diabetic patient with ESRD is a challenge
for the nephrologist with regard to the type of renal replacement therapy that should
be suggested and offered to the patient. There is no evidence that either peritoneal
dialysis or hemodialysis is contraindicated in obese ESRD patients. In the literature,
we can find a discrepancy in the impact of obesity on mortality among hemodialysis
vs. peritoneal dialysis patients. Several studies in hemodialysis patients suggest
that a higher BMI confers a survival advantage — the so-called “reverse epidemiology”.
In contrast, the literature among obese peritoneal dialysis patients is inconsistent,
with various studies reporting an increased risk of death, no difference, or a decreased
risk of death. Many of these studies only spanned across a few years, and this is
probably too short of a time frame for a realistic assessment of obesity's impact
on mortality in ESRD patients.
The decision for dialysis modality in an obese diabetic patient with ESRD should be
individualized. According to the results of published studies, we cannot suggest PD
or HD as a better solution for all obese diabetic patients. The obese patient should
be educated about all their dialysis options, including home dialysis therapies.
In this review, the available literature related to the dialysis modality in obese
patients with diabetes and ESRD was reviewed.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Internal MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Renal risk and renoprotection among ethnic groups withtype 2 diabetic nephropathy: a post hoc analysis of RENAAL.Kidney Int. 2006; 69: 1675-1682
- Prevention and treatment of diabetic renal disease in type 2 diabetes: the BENEDICT study.J Am Soc Nephrol. 2006; 17: S90-S97
- Obesity and diabetic kidney disease.Med Clin North Am. 2013; 97: 59-74
- Annual data report: Atlas of end-stage renal disease in the United States.(Available from:)Date: 2011
- The dialysis outcomes and practice patterns study (DOPPS): how can we improve the care of hemodialysis patients?.Semin Dial. 2001; 14: 157-159
- Dialysis modality choice in diabetic patients with end-stage kidney disease: a systematic review of the available evidence.Nephrol Dial Transplant. 2015; 30: 310-320
- Survival advantages of obesity in dialysis patients.J Clin Nutr. 2005; 81: 543-554
- Influence of excess weight on mortality and hospital stay in 1346 hemodialysis patients.Kidney Int. 1999; 55: 1560-1567
- Body mass index and mortality in ‘healthier’ as compared with ‘sicker’ haemodialysis patients: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS).Nephrol Dial Transplant. 2001; 16: 2386-2394
- Body weight-for-height relationships predict mortality in maintenance hemodialysis patients.Kidney Int. 1999; 56: 1136-1148
- Body size, dialysis dose and death risk relationships among hemodialysis patients.Kidney Int. 2002; 62: 1891-1897
- Dialysis dose and body mass index are strongly associated with survival in hemodialysis patients.J Am Soc Nephrol. 2002; 13: 1061-1066
- Factors associated with improved short-term survival in obese end stage renal disease patients.Ann Epidemiol. 2003; 13: 136-143
- Association of body size with outcomes among patients beginning dialysis.Am J Clin Nutr. 2004; 80: 324-332
- Body size, dose of hemodialysis, and mortality.Am J Kidney Dis. 2000; 35: 80-88
- 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: 597-605
- Effect of starting with hemodialysis compared with peritoneal dialysis in patients new on dialysis treatment: a randomized controlled trial.Kidney Int. 2003; 64: 2222-2228
- Association between body mass index and mortality is similar in the hemodialysis population and the general population at high age and equal duration of follow-up.J Am Soc Nephrol. 2007; 18: 967-974
- Nephrol Dial Transplant. 2015; 30: ii1-ii142
- Relationships between the body mass index and body composition.Obes Res. 1996; 4: 35-44
- Body mass index, muscle and fat in chronic kidney disease: questions about survival.Nephrol Dial Transplant. 2008; 23: 2461-2466
- The adipose tissue production of adiponectin is increased in end-stage renal disease.Kidney Int. 2013; 83: 487-494
- Adipose tissue cytokines, insulin sensitivity, inflammation, and cardiovascular outcomes in end-stage renal disease patients.J Ren Nutr. 2005; 15: 125-130
- Relationship between adiposity, adipokines, inflammatory markers and lipid profile in hemodialysis patients.Eur Rev Med Pharmacol Sci. 2014; 18: 1496-1498
- Usefulness of waist circumference as a marker of abdominal adiposity in peritoneal dialysis: a cross-sectional and prospective analysis.Nephrol Dial Transplant. 2012; 27: 790-795
- Peritoneal dialysis is not a superior therapy to hemodialysis: a comparison.Blood Purif. 2012; 33: 160-164
- Mortality risk factors in patients treated bychronic hemodialysis. Report of the Diaphane collaborative study.Nephron. 1982; 31: 103-110
- Simple nutritional indicators as independent predictors of mortality in hemodialysis patients.Am J Kidney Dis. 1998; 31: 997-1006
- Is there any survival advantage of obesity in Southern European haemodialysis patients?.Nephrol Dial Transplant. 2009; 24: 2871-2876
- Comparison of mortality between Japanese peritoneal dialysis and hemodialysis patients: a 5-year multicenter follow-up study.Int J Nephrol. 2012; 2012: 231018
- Effect of age and dialysis vintage on obesity paradox in long-term hemodialysis patients.Am J Kidney Dis. 2014; 63: 612-622
- Obesity paradox in end-stage kidney disease patients.Prog Cardiovasc Dis. 2014; 56: 415-425
- Obesity and atherosclerotic events in chronic hemodialysis patients: a prospective study.Nephrol Dial Transplant. 2013; 28: iv 188-iv 194
- Continuous ambulatory peritoneal dialysis: three-year experience at one center.Ann Intern Med. 1980; 92: 609-613
- Continuous ambulatory peritoneal dialysis (CAPD): an established treatment for end stage renal failure.Aust N Z J Med. 1983; 13: 489-496
- US nephrologists' recommendation of dialysis modality: results of a national survey.Am J Kidney Dis. 2000; 36: 1155-1165
- Frequency and microbiology of peritonitis and exit-site infection among obese peritoneal dialysis patients.Perit Dial Int. 2013; 33: 167-174
- Impact of initial dialysis modality and modality switches on Medicare expenditures of end-stage renal disease patients.Kidney Int. 2005; 68: 319-329
- Preservation of residual renal function in dialysis patients: effects of dialysis-technique-related factors.Perit Dial Int. 2001; 21: 52-57
- Predictors of the rate of decline of residual renal function in incident dialysis patients.Kidney Int. 2002; 62: 1046-1053
- Patient ratings of dialysis care with peritoneal dialysis vs hemodialysis.JAMA. 2004; 291: 697-703
- Cross-sectional comparison of quality of life and illness intrusiveness in patients who are treated with nocturnal home hemodialysis versus peritoneal dialysis.Clin J Am Soc Nephrol. 2007; 2: 1195-1200
- Body mass index and peritoneal dialysis: “exceptions to the exception” in reverse epidemiology?.Semin Dial. 2007; 20: 561-565
- Neither size nor weight predicts survival in peritoneal dialysis patients.Perit Dial Int. 1996; 16: 357-361
- Large body mass index does not predict short-term survival in peritoneal dialysis patients.Perit Dial Int. 2002; 22: 191-196
- Is obesity a favorable prognostic factor in peritoneal dialysis patients?.Perit Dial Int. 2000; 20: 715-721
- Body mass index as a predictor of continued survival in older chronic dialysis patients.Int Urol Nephrol. 2001; 32: 441-448
- Body size and outcomes on peritoneal dialysis in the United States.Kidney Int. 2003; 64: 1838-1844
- What is the optimal fat mass in peritoneal dialysis patients?.Perit Dial Int. 2007; 27: S250-S254
- Mortality studies comparing peritoneal dialysis and hemodialysis: what do they tell us?.Kidney Int Suppl. 2006; 103 ([Review]): S3-11
- Peritoneal dialysis outcomes in a modern cohort of overweight patients.Int Urol Nephrol. 2014; 46: 183-189
- Netherlands Cooperative Study on the Adequacy of Dialysis Study Group. Hemodialysis and peritoneal dialysis: comparison of adjusted mortality rates according to the duration of dialysis: analysis of The Netherlands Cooperative Study on the Adequacy of Dialysis 2.J Am Soc Nephrol. 2003; 14: 2851-2860
- Effect of body mass index on outcomes of peritoneal dialysis patients in India.Perit Dial Int. 2014; 34: 399-408
- Body mass index and mortality risk in Asian peritoneal dialysis patients in Hong Kong-impact of diabetes and cardiovascular disease status.Perit Dial Int. 2014; 34: 390-398
- The association between body mass index and mortality on peritoneal dialysis: a prospective cohort study.Perit Dial Int. 2014; 34: 383-389
- Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies.Lancet. 2004; 363: 157-163
- Is obesity associated with a survival advantage in patients starting peritoneal dialysis?.Contrib Nephrol. 2009; 163: 124-131
- Reverse epidemiology in peritoneal dialysis patients: the Canadian experience and review of the literature.Int Urol Nephrol. 2007; 39: 281-288
- Influence of initial nutritional status on continuous ambulatory peritoneal dialysis patient survival.Perit Dial Int. 2000; 20: 19-26
- J Am Soc Nephrol. 1996; 7: 198-207
- Peritoneal and hemodialysis: II. Mortality risk associated with initial patient characteristics.Kidney Int. 2002; 61: 741-746
- Is malnutrition an independent predictor of mortality in peritoneal dialysis patients?.Nephrol Dial Transplant. 2003; 18: 2134-2140
- Effect of body size and body composition on survival in peritoneal dialysis patients.Perit Dial Int. 2005; 25: 461-469
- IDF diabetes atlas.6th ed. International Diabetes Federation, Brussels, Belgium2013 ((Available from: https://www.idf.org/sites/default/files/EN_6E_Atlas_Full_0.pdf)
- Associations of body mass index and weight loss with mortality in transplant-waitlisted maintenance hemodialysis patients.Am J Transplant. 2011; 11: 725-736
- Association of morbid obesity and weight change over time with cardiovascular survival in hemodialysis population.Am J Kidney Dis. 2005; 46: 489-500
- The obesity paradox and mortality associated with surrogates of body size and muscle mass in patients receiving hemodialysis.Mayo Clin Proc. 2010; 85: 991-1001
- Unintentional weight loss is an independent predictor of mortality in a hemodialysis population.J Ren Nutr. 2010; 20: 414-418
- Mortality prediction by surrogates of body composition: an examination of the obesity paradox in hemodialysis patients using composite ranking score analysis.Am J Epidemiol. 2012; 175: 793-803
- Temporal evolution of clinical parameters before death in dialysis patients: a new concept.Blood Purif. 2009; 27: 38-47
- Relationship of body size and initial dialysis modality on subsequent transplantation, mortality and weight gain of ESRD patients.Nephrol Dial Transplant. 2012; 27: 3631-3638
- The association between body mass index and mortality in incident dialysis patients.PLoS One. 2014; 9 ([eCollection 2014])e114897https://doi.org/10.1371/journal.pone.0114897
- Effect of obesity on PD versus survival: is caloric intake the discriminating factor?.Kidney Int. 2004; 866: 66
- Peritoneal physiology-transport of solutes.in: Gokal R. Nolph K.D. The textbook of peritoneal dialysis. Kluwer Academic Publishers, Dordrecht, Netherlands1994: 69-114
- Is the declining use of long-term peritoneal dialysis justified by outcome data?.Clin J Am Soc Nephrol. 2007; 2: 1317-1328
- Predicting a patient's choice of dialysis modality: experience in a United Kingdom renal department.Am J Kidney Dis. 2001; 37: 981-986
- The effect of contraindications and patient preference on dialysis modality selection in ESRD patients in the Netherlands.Am J Kidney Dis. 2004; 43: 891-899
- Patient education and access of ESRD patients to renal replacement therapies beyond in-center hemodialysis.Kidney Int. 2005; 68: 378-390
- Chronic peritoneal dialysis in the United States: improving outcomes but declining utilization.J Am Soc Nephrol. 2007; 18: 2781-2788
- Obesity is associated with worse peritoneal dialysis outcomes in the Australia and New Zealand patient populations.J Am Soc Nephrol. 2003; 14: 2894-2901
- Is CAPD an effective treatment for ESRD patients with a weight over 80 kg?.Clin Nephrol. 1997; 47: 389-393
- Peritoneal dialysis in patients with high body-mass index.Wien Klin Wochenschr. 2005; ([Review. German]): 40-45
- Weight limitations for weekly urea clearances using various exchange volumes in continuous ambulatory peritoneal dialysis.Perit Dial Int. 1994; 14: 261-264
- Feasibility of adequate solute clearance in obese patients on peritoneal dialysis.Am J Kidney Dis. 2002; 40: 1295-1300
- Four-year experience with swan neck presternal peritoneal dialysis catheter.Am J Kidney Dis. 1996; 27: 99-105
- Update on peritoneal dialysis: core curriculum 2016.Am J Kidney Dis. 2015; ([pii: S0272-6386(15)01064-1])
- Racial and ethnic differences in the association of body mass index and survival in maintenance hemodialysis patients.Am J Kidney Dis. 2011; 58: 574-582
- Relationship of body size and mortality among US Asians and Pacific Islanders on dialysis.Ethn Dis. 2011; 21: 40-46
- Mortality predictability of body size and muscle mass surrogates in Asian vs white and African American hemodialysis patients.Mayo Clin Proc. 2013; 88: 479-486
- Survival differences between peritoneal dialysis and hemodialysis among “large” ESRD patients in the United States.Kidney Int. 2004; 65: 2398-2408
Article info
Publication history
Published online: April 07, 2016
Accepted:
March 18,
2016
Received in revised form:
February 20,
2016
Received:
December 20,
2015
Identification
Copyright
© 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
