Factors Associated with Improved Short Term Survival in Obese End Stage Renal Disease Patients

Glanton, Christopher W.; Hypolite, Iman O.; Hshieh, Paul; Agodoa, Lawrence Y.; Yuan, Christina M.; Abbott, Kevin C.

doi:10.1016/s1047-2797(02)00251-x

Cited by 79 publications

(60 citation statements)

References 36 publications

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“…Another plausible hypothesis is that metabolic syndrome or its individual components are expressed differently in more advanced stages of CKD. Studies suggest a paradoxical association with obesity and reduced mortality in hemodialysis patients and in the elderly and heart failure populations (20,21). This study confirms previous reports and suggests that in advanced CKD, obesity may be protective.…”

supporting

confidence: 90%

Metabolic Syndrome, CKD Progression, and Death

Lea

2013

Clinical Journal of the American Society of Nephrology

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Previous studies have reported an association between metabolic syndrome, proteinuria, incidence and progression of CKD, and ESRD among different ethnic groups (1-6). With an increasing sedentary lifestyle and high rates of obesity, the prevalence of metabolic syndrome stands at 34% (7). The burden of incident and prevalent CKD has also increased in the United States; thus, CKD and metabolic syndrome, in addition to obesity, are major public health problems. Metabolic syndrome is defined by central obesity, hyperglycemia, hypertension, and dyslipidemia (8,9). Diabetes and hypertension are the leading causes of both CKD and ESRD. Because both elevated blood glucose and BP are included in the definition of metabolic syndrome, it is not surprising that recent data suggest a link between metabolic syndrome and CKD. Moreover, metabolic syndrome in the general population increases risk of cardiovascular disease, stroke, and all-cause mortality, as do CKD and microalbuminuria (10). It has not been clear whether these effects of metabolic syndrome are driven by one or more individual factors, are due to clustering of risk factors, or perhaps result from some other concomitant factors. In addition, it is unclear whether the consequences of metabolic syndrome differ according to level of CKD.In this issue of CJASN, Navaneethan and colleagues (11) tackle the subject of metabolic syndrome, CKD progression, and death in a large (n525,868) and diverse population with stage 3-4 CKD. They used a preexisting electronic health record-based CKD registry. The definition of metabolic syndrome was modified from that used by the National Cholesterol Education Program, with body mass index (BMI) instead of waist circumference. This is an acceptable alternative used in the World Health Organization classification of metabolic syndrome and in other similar studies (9). Sixty percent of the cohort was defined as having metabolic syndrome. Multivariate analyses for several risk factors known to influence CKD progression and death showed that metabolic syndrome was associated with an increased risk for ESRD but not for death during a mean follow-up of 2.3 years. Subgroup analyses conducted in patients with urine protein measurements showed that the presence of proteinuria was associated with an increased risk of ESRD and death. Those with metabolic syndrome had much higher odds of proteinuria even after covariate adjustment; however, when the prior ESRD analyses were adjusted for proteinuria, there was no longer an association of metabolic syndrome with ESRD. We previously reported in a secondary analysis of the African-American Study of Kidney Disease and Hypertension (AASK) an association of 31% increased risk of CKD progression to ESRD or death in patients who met criteria for metabolic syndrome, but this was attenuated and no longer significant when adjusted for proteinuria (4). These findings, coupled with those from the current study, suggest that proteinuria may play an important role in the effect of metabolic syndrome on CKD progre...

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supporting

confidence: 90%

Metabolic Syndrome, CKD Progression, and Death

Lea

2013

Clinical Journal of the American Society of Nephrology

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“…[58][59][60][61][62][63][64][65] However, overall survival is substantially and significantly improved in dialysis-dependent obese patients compared with their counterparts remaining on the wait list. 66,67 Whether weight loss is beneficial and results in better outcomes in transplant recipients and whether the paradoxical association of BMI and mortality applies in transplant recipients are unknown. The safety of intentional weight loss in stable dialysis patients as well as patients who go on to receive kidney transplants has not been prospectively studied.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Renal Function on Outcomes of Bariatric Surgery

Turgeon

Perez

Mondestin³

et al. 2012

Journal of the American Society of Nephrology

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The effect of CKD on the risks of bariatric surgery is not well understood. Using the American College of Surgeons National Surgical Quality Improvement Program Participant Use File, we analyzed 27,736 patients who underwent bariatric surgery from 2006 through 2008. Before surgery, 34 (0.12%) patients were undergoing long-term dialysis. Among those not undergoing dialysis, 20,806 patients (75.0%) had a normal estimated GFR or stage 1 CKD, 5011 (18.07%) had stage 2 CKD, 1734 (6.25%) had stage 3 CKD, 94 (0.34%) had stage 4 CKD, and 91 (0.33%) had stage 5 CKD. In an unadjusted analysis, CKD stage was directly associated with complication rate, ranging from 4.6% for those with stage 1 CKD or normal estimated GFR to 9.9% for those with stage 5 CKD (test for trend, P,0.001). Multivariable logistic regression demonstrated that CKD stage predicts higher complication rates (odds ratio for each higher CKD stage, 1.30) after adjustment for diabetes and hypertension. Although patients with higher CKD stage had higher complication rates, the absolute incidence of complications remained ,10%. In conclusion, these data demonstrate higher risks of bariatric surgery among patients with worse renal function, but whether the potential benefits outweigh the risks in this population requires further study.

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“…The paradoxical association between traditional cardiovascular risk factors and better outcomes in dialysis patients probably reflects the powerful effect-modifying impact of PEW in this population (2,3). Such is the case of the "obesity paradox," whereby a high body mass index (BMI) has been associated with longer survival in many (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) but not all (16)(17)(18)) studies of dialysis patients. Although there are various hypotheses for this paradoxical disconnect, the most likely explanation is that dialysis patients are at such high risk of PEW that excess weight provides a measure of protection (15,19).…”

Section: Introductionmentioning

confidence: 99%

Influence of Body Mass Index on the Association of Weight Changes with Mortality in Hemodialysis Patients

Cabezas-Rodríguez¹,

Carrero²,

Zoccali³

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and Objectives A high body mass index (BMI) is associated with lower mortality in patients undergoing hemodialysis. Short-term weight gains and losses are also related to lower and higher mortality risk, respectively. The implications of weight gain or loss may, however, differ between obese individuals and their nonobese counterparts. Results Among 6296 patients with complete data, 1643 died. At study entry, 42% of patients had a normal weight (BMI, 20-25 kg/m 2 ), 11% were underweight, 31% were overweight, and 16% were obese (BMI $30 kg/m 2 ). Weight loss or gain (,1% or .1% of body weight) was strongly associated with higher rates of mortality or survival, respectively. After stratification by BMI categories, this was true in nonobese categories and especially in underweight patients. In obese patients, however, the association between weight loss and mortality was attenuated (hazard ratio, 1.28 [95% confidence interval (CI), 0.74 to 2.14]), and no survival benefit of gaining weight was seen (hazard ratio, 0.98 [95% CI, 0.59 to 1.62]).Conclusions Assuming that these weight changes were unintentional, our study brings attention to rapid weight variations as a clinical sign of health monitoring in hemodialysis patients. In addition, a patient's BMI modifies the strength of the association between weight changes with mortality.

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Factors Associated with Improved Short Term Survival in Obese End Stage Renal Disease Patients

Cited by 79 publications

References 36 publications

Metabolic Syndrome, CKD Progression, and Death

Metabolic Syndrome, CKD Progression, and Death

The Impact of Renal Function on Outcomes of Bariatric Surgery

Influence of Body Mass Index on the Association of Weight Changes with Mortality in Hemodialysis Patients

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