Body size and longitudinal body weight changes do not increase mortality in incident peritoneal dialysis patients of the Brazilian peritoneal dialysis multicenter study

Abstract

OBJECTIVES:To determine the roles of body size and longitudinal body weight changes in the survival of incident peritoneal dialysis patients.PATIENTS AND METHODS:Patients (n = 1911) older than 18 years of age recruited from 114 dialysis centers (Dec/2004-Oct/2007) and participating in the Brazilian Peritoneal Dialysis Multicenter Cohort Study were included. Clinical and laboratory data were collected monthly (except if the patient received a transplant, recovered renal function, was transferred to hemodialysis, or died).RESULTS:Survival analyses were performed using Kaplan-Meier survival curves and Cox proportional hazards. Total follow-up was 34 months. The mean age was 59 years (54% female). The weight category percentages were as follows: underweight: 8%; normal: 51%; overweight: 29%; and obese 12%. The multivariate model showed a higher risk of death for a body mass index <18.5 kg/m2, a neutral risk between 25 and 29.9 kg/m2 and a protective effect for an index >30 kg/m2. Patients were divided into five categories according to quintiles of body weight changes during the first year of dialysis: <−3.1%, −3.1 to+0.12%, +0.12 to <+3.1% (reference category), +3.1 to +7.1% and >+7.1%. Patients in the lowest quintile had significantly higher mortality, whereas no negative impact was observed in the other quintiles.CONCLUSION:These findings suggest that overweight/obesity and a positive body weight variation during the first year of peritoneal dialysis therapy do not increase mortality in incident dialysis patients in Brazil.

Association of Body Mass Index with Mortality in Peritoneal Dialysis Patients: A Systematic Review and Meta-Analysis

“…Subsequently, 442 citations were evaluated based on their full text article ( Figure 1). We finally included 61 studies of the association of BMI with mortality in chronic kidney diseases, and segregated the 8 studies of patients who received PD (Table 1) (8)(9)(10)(11)(12)(13)(14)(15)). An additional study was identified through consulting field experts (16).…”

“…All included studies comprised cohorts from pre-existing registry data and reported hazard ratios (HRs) from survival regression models. The utilized registries included the United States Renal Data System (USRDS) (11,(13)(14)(15)(16), the Australian and New Zealand Dialysis and Transplantation Registry (ANZDATA) (10,12), the Canadian Organ Replacement Register (CORR) (9), and the Brazilian Peritoneal Dialysis Multicenter Study (BRAZPD) (8). All included studies had a low risk of bias with a quality score range of 7 to 9 out of 9 ( Supplementary Table S2).…”

“…Fernandes et al (8) also assessed the association of weight change (in addition to the baseline BMI) with all-cause mortality in PD patients. They observed that a ≥ 3.1% decrease in normalized weight was associated with a significantly higher mortality.…”

The Current State of Peritoneal Dialysis

“…[111][112][113][114][115][116][117] Yet, the evidence that they translate into significantly worse outcomes for PD patients is variable. 118,[122][123][124] One potential shortcoming of the registry analyses is the use of body mass index as surrogate for obesity which may underestimate fat gain in PD patients; the preferred use of waist circumference in defining metabolic syndrome is also hard to validate in PD patients in whom abdominal girth measurements are influenced by intra-abdominal fluid. Patients gain weight after starting PD, and this is closely mirrored by an increase in total cholesterol and fat mass.…”

Continuous ambulatory peritoneal dialysis: perspectives on patient selection in low- to middle-income countries

“…[86][87][88] Despite this, physicians are less likely to prescribe CAPD for obese patients owing to concerns about inadequate ultrafiltration, solute clearance, exit site infections, and peritonitis. 89 In LMICs, obese people are likely to be excluded from publicly funded programs mainly due to the policy of rationing and also due to the bias for several complications and poor outcome of kidney transplantation of obese patients (reviewed extensively in Tran et al). 90 Well-motivated, appropriately pre-dialysis educated and trained patients may be offered the choice of CAPD.…”