Changes in Body Weight and Subsequent Mortality

Kövesdy, Csaba P.; Kalantar-Zadeh, Kamyar

doi:10.2215/cjn.08260813

Cited by 2 publications

(2 citation statements)

References 22 publications

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“…In addition, a well-designed epidemiologic study could provide insights about the mechanisms through which PEW and/or inflammation are associated with poor outcomes in ESRD patients. [89]…”

Section: Introductionmentioning

confidence: 99%

Obesity Paradox in End-Stage Kidney Disease Patients

Park

Ahmadi

Streja

et al. 2014

Progress in Cardiovascular Diseases

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305

241

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In the general population, obesity is associated with increased cardiovascular risk and decreased survival. In patients with end-stage renal disease (ESRD), however, an “obesity paradox” or “reverse epidemiology” (to include lipid and hypertension paradoxes) has been consistently reported, i.e. a higher body mass index (BMI) is paradoxically associated with better survival. This survival advantage of large body size is relatively consistent for hemodialysis patients across racial and regional differences, although published results are mixed for peritoneal dialysis patients.. Recent data indicate that both higher skeletal muscle mass and increased total body fat are protective, although there are mixed data on visceral (intra-abdominal) fat. The obesity paradox in ESRD is unlikely to be due to residual confounding alone and has biologic plausibility. Possible causes of the obesity paradox include protein-energy wasting and inflammation, time discrepancy among competitive risk factors (undernutrition versus overnutrition), hemodynamic stability, alteration of circulatory cytokines, sequestration of uremic toxin in adipose tissue, and endotoxin-lipoprotein interaction. The obesity paradox may have significant clinical implications in the management of ESRD patients especially if obese dialysis patients are forced to lose weight upon transplant wait-listing. Well-designed studies exploring the causes and consequences of the reverse epidemiology of cardiovascular risk factors, including the obesity paradox, among ESRD patients could provide more information on mechanisms. These could include controlled trials of nutritional and pharmacologic interventions to examine whether gain in lean body mass or even body fat can improve survival and quality of life in these patients.

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“…In addition, a well-designed epidemiologic study could provide insights about the mechanisms through which PEW and/or inflammation are associated with poor outcomes in ESRD patients. [89]…”

Section: Introductionmentioning

confidence: 99%

Obesity Paradox in End-Stage Kidney Disease Patients

Park

Ahmadi

Streja

et al. 2014

Progress in Cardiovascular Diseases

Self Cite

305

241

View full text Add to dashboard Cite

show abstract

“…11 In contrast, observational cohort studies reported increased risk of mortality with weight loss in CKD patients prior to initiation of dialysis 22 and in patients on chronic maintenance dialysis. 23–26 These observational studies of weight loss in CKD and dialysis patients are limited by the lack of data on whether the weight loss was intentional or unintentional, 27,28 as unintentional weight loss might reflect an underlying comorbidity such as cancer or severe intercurrent illness.…”

Section: Discussionmentioning

confidence: 99%