Effect of Body Mass Index on Outcomes of Peritoneal Dialysis Patients in India

Prasad, Narayan; Sinha, Archana; Gupta, Amit; Sharma, Raj Kumar; Bhadauria, Dharmendra; Chandra, Abhilash; Prasad, Kashi Nath; Kaul, Anupama

doi:10.3747/pdi.2013.00056

Cited by 40 publications

(46 citation statements)

References 38 publications

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“…Contrary to their results, Prasad et al [14] found no changes in HR for mortality between incident patients with BMI >25 kg/m 2 compared to BMI 18.5-22.9 kg/m 2 and 23-24.9 kg/m 2 , with the group of patients with BMI <18 kg/m 2 having an increased HR for mortality. Furthermore, Mehrotra et al [15] performed a study comparing outcomes of continuous ambulatory versus automated PD.…”

Section: Peritoneal Dialysis In Extremely Morbid Obese Patientscontrasting

confidence: 39%

Challenges Associated with Managing End-Stage Renal Disease in Extremely Morbid Obese Patients: Case Series and Literature Review

Turgut

Abdel‐Rahman

2017

Nephron

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Obesity has grown into an epidemic across the globe. Mirroring this growth in the number of obese individuals in the general population, the prevalence of obesity and extremely morbid obesity (body mass index >50 kg/m<sup>2</sup>) is similarly rising in patients with end-stage renal disease (ESRD). Obesity, and more so, extremely morbid obesity, creates additional challenges for clinicians aiming at providing the best treatment options to patients with ESRD. Although literature is available regarding renal replacement therapy (RRT) for obese patients, literature about challenges facing clinicians managing ESRD in the extremely obese patients is lacking. Furthermore, the optimal strategies and goals for managing these patients with ESRD are not well defined. To our knowledge, no study has been done evaluating RRT options available to extremely morbid obese patients and the challenges associated with these options. Here, we report a case series and discuss the potential challenges faced by extremely obese patients with ESRD requiring RRT.

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Section: Peritoneal Dialysis In Extremely Morbid Obese Patientscontrasting

confidence: 39%

Challenges Associated with Managing End-Stage Renal Disease in Extremely Morbid Obese Patients: Case Series and Literature Review

Turgut

Abdel‐Rahman

2017

Nephron

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“…The reported median patient survival in underweight, normal, overweight and obese patients was 26, 50, 57.7 and 49 patient-months, respectively. It was found that obese PD patients had a significantly greater risk of peritonitis [38]. Therefore all the above studies consistently showed that underweight in PD patients conferred worse survival, and this is particularly a problem in Asia where a significant proportion of patients suffer from malnutrition.…”

Section: Issues Related To Peritoneal Dialysis In Asian Countriesmentioning

confidence: 98%

Peritoneal Dialysis in Asia

Kwong¹,

Li²

2015

Kidney Dis

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Background: There is a growing demand of dialysis in Asia for end-stage renal failure patients. Diabetes mellitus is the leading cause of end-stage renal failure in many countries in Asia. Summary: The growth of peritoneal dialysis (PD) in Asia is significant and seeing a good trend. With the enhanced practices of PD, the quality of care in PD in Asia is also improved. Overall, PD and hemodialysis (HD) are comparable in clinical outcome. There is a global trend in the reduction of peritonitis rates and Asian countries also witness such improvement. The socio-economic benefits of PD for end-stage renal failure patients in both urban and rural areas in the developed and developing regions of Asia are an important consideration. This can help to reduce the financial burden of renal failure in addressing the growing demand of patients on dialysis. Initiatives should be considered to further drive down the cost of PD in Asia. Key Messages: Growing demand for dialysis by an increasing number of end-stage renal failure patients requires the use of a cost-effective quality dialysis modality. PD is found to be comparable to HD in outcome and quality. In most countries in Asia, PD should be more cost-effective than HD. A ‘PD-first' or a ‘PD as first considered therapy' policy can be an overall strategy in many countries in Asia in managing renal failure patients, taking the examples of Hong Kong and Thailand. Facts from East and West: (1) PD is cheaper than HD and provides a better quality of life worldwide, but its prevalence is significantly lower than that of HD in all countries, with the exception of Hong Kong. Allowing reimbursement of PD but not HD has permitted to increase the use of PD over HD in many Asian countries like Hong Kong, Vietnam, Taiwan, Thailand, as well as in New Zealand and Australia over the last years. In the Western world, however, HD is still promoted, and the proportion of patients treated with PD decreases. Japan remains an exception in Asia where PD penetration is very low. Lack of adequate education of practitioners and information of patients might as well be reasons for the low penetration of PD in both the East and West. (2) Patient survival of PD varies between and within countries but is globally similar to HD. (3) Peritonitis remains the main cause of morbidity in PD patients. South Asian countries face specific issues such as high tuberculosis and mycobacterial infections, which are rare in developed Asian and Western countries. The infection rate is affected by climatic and socio-economic factors and is higher in hot, humid and rural areas. (4) Nevertheless, the promotion of a PD-first policy might be beneficial particularly for remote populations in emerging countries where the end-stage renal disease rate is increasing dramatically.

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“…Often referred to as the “obesity paradox”, studies in HD patients have consistently demonstrated that higher BMI (BMI >30 kg/m 2 ) is associated with improved survival . In contrast, results have been variable in regards to the association of obesity with mortality in PD patients . In a study directly comparing both treatments in 134 728 incident dialysis patients, the relative mortality risk of PD compared to HD increased with increasing BMI an effect that was more pronounced among diabetic patients .…”

Section: Survival By Modality: Specific Patient Subgroups and Interacmentioning

confidence: 99%

“…[40][41][42][43][44] In contrast, results have been variable in regards to the association of obesity with mortality in PD patients. [45][46][47][48][49][50][51] In a study directly comparing both treatments in 134 728 incident dialysis patients, the relative mortality risk of PD compared to HD increased with increasing BMI an effect that was more pronounced among diabetic patients. 45 However, being underweight, variously defined as <18.5 to <20.9 kg/m 2 , is associated with similarly worse outcomes in both modalities.…”

Section: A Modern Day Perspectivementioning

confidence: 99%

Dialysis modality and survival: Done to death

Trinh

Chan

Perl

2018

Seminars in Dialysis

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The debate surrounding whether peritoneal dialysis or hemodialysis is associated with differential survival continues as the numerous comparative studies over the past 3 decades have yielded conflicting results. Findings have also evolved over time in the setting of changing patient characteristics, advances in dialytic technologies, and the use of more robust statistical and epidemiologic approaches. Here, we will critically review the body of evidence, both historical and contemporary, comparing survival across dialysis modalities. Significant limitations of the observational nature of the current literature will be highlighted given that no adequately powered randomized controlled trials exist. Given the lack of consistency and limitations of current studies, coupled with the poor survival across both modalities, we can likely conclude that survival comparisons between both modalities do not appreciably differ. Hence, the choice of dialysis modality should not be dictated by survival comparisons, but rather be based on an individualized and informed decision making that places patient preference and lifestyle considerations at the forefront, while integrating medical factors and availability of resources and support. The emphasis of future research should move beyond survival outcomes when comparing dialysis modalities, and instead be redirected to patient-endorsed and patient-reported outcomes.

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Effect of Body Mass Index on Outcomes of Peritoneal Dialysis Patients in India

Cited by 40 publications

References 38 publications

Challenges Associated with Managing End-Stage Renal Disease in Extremely Morbid Obese Patients: Case Series and Literature Review

Challenges Associated with Managing End-Stage Renal Disease in Extremely Morbid Obese Patients: Case Series and Literature Review

Peritoneal Dialysis in Asia

Dialysis modality and survival: Done to death

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