Obi Y, et al. - This study sheds light on the association between obesity and clinical outcomes among patients with end-stage kidney disease in the current era. Findings demonstrated that in comparison to nonobese peritoneal dialysis (PD) patients, a higher risk for complications was reported in obese PD patients and, their survival was no worse than matched hemodialysis (HD) patients.

Methods

• This historical cohort study included a total of 15,573 incident PD patients from a large US dialysis organization (2007-2011).
• As predictor, body mass index (BMI) was included and outcomes included modality longevity, residual renal creatinine clearance, peritonitis, and survival.

Results

• Findings demonstrated a significant association of higher BMI 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).
• Obese patients vs lean patients had faster declines in residual kidney function (P for trend < 0.001) and the former group 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).
• Researchers observed a U-shaped link between BMI and mortality, with the greatest survival related to the BMI range of 30 to < 35 kg/m² in the case-mix adjusted model.
• They also noted that PD patients vs matched HD patients had lower mortality in the BMI categories of < 25 and 25 to < 35 kg/m² and had equivalent survival in the BMI category ≥ 35 kg/m² (P for interaction = 0.001 [vs < 25 kg/m²]).
• Data reported that this reduction in survival difference among patients with severe obesity was observed only in patients with diabetes, but not those without diabetes.