Fat tissue and inflammation in patients undergoing peritoneal dialysis

Abstract

BackgroundBody weight has been increasing in the general population and is an established risk factor for hypertension, diabetes, and all-cause and cardiovascular mortality. Patients undergoing peritoneal dialysis (PD) gain weight, mainly during the first months of treatment. The aim of this study was to assess the relationship between body composition and metabolic and inflammatory status in patients undergoing PD.MethodsThis was a prospective, non-interventional study of prevalent patients receiving PD. Body composition was studied every 3 months using bioelectrical impedance (BCM®). We performed linear regression for each patient, including all BCM® measurements, to calculate annual changes in body composition. Thirty-one patients in our PD unit met the inclusion criteria.ResultsMedian follow-up was 26 (range 17–27) months. Mean increase in weight was 1.8 ± 2.8 kg/year. However, BCM® analysis revealed a mean increase in fat mass of 3.0 ± 3.2 kg/year with a loss of lean mass of 2.3 ± 4.1 kg/year during follow-up. The increase in fat mass was associated with the conicity index, suggesting that increases in fat mass are based mainly on abdominal adipose tissue. Changes in fat mass were directly associated with inflammation parameters such as C-reactive protein (r = 0.382, P = 0.045) and inversely associated with high-density lipoprotein cholesterol (r=−0.50, P = 0.008).ConclusionsFollow-up of weight and body mass index can underestimate the fat mass increase and miss lean mass loss. The increase in fat mass is associated with proinflammatory state and alteration in lipid profile.

Association between Dyslipidemia and Peritoneal Dialysis Technique Survival

“…Also, the exact mechanism by which dyslipidemia affects a higher risk of all-cause technique failure remains unclear. On the other hand, the association between pro-atherogenic lipid profile and longer PD duration [26], a decrease in RRF [20], [27] and glucose absorption from the dialysis fluid [28], [29] can be a possible explanation of a higher risk of all-cause technique failure.…”

“…Moreover, we observed a significant decrease in residual diuresis in dyslipidemia conditions. Additionally, fluid and weight control problems are common amongst PD patients and may be accompanied by dyslipidemia [16], [20], [25], [29], [31]. Rincón et al found the mean increase in fat mass of 3.0 ± 3.2 kg/year during the 26-month-follow-up period.…”

“…Rincón et al found the mean increase in fat mass of 3.0 ± 3.2 kg/year during the 26-month-follow-up period. Changes in fat mass were directly associated with an inverse correlation between fat mass and HDL in PD patients [28]. Besides, they concluded that changes in body composition in patients undergoing PD might affect other parameters, namely, alteration in lipid profile [28].…”

“…This condition may be associated with glucose absorption from the peritoneal dialysate, peritoneal protein loss and a decrease in residual renal function (RRF) [11], [12], [15]. Also, PD treatment leads to body weight gain, and it can also be a potential risk factor for accelerated atherosclerosis [16], [17], [18].…”

Three compartment bioimpedance spectroscopy in the nutritional assessment and the outcome of patients with advanced or end stage kidney disease: What have we learned so far?

“…Whereas a low LTI was related to FO and inflammation, the study of Lee et al showed that in male subjects, the FM/LTM ratio was also positively related to hsCRP and interleukin‐6 . In PD patients, changes in FTI were also positively related to changes in inflammatory status . This has mainly been attributed to the relation between visceral adiposity and systemic inflammation .…”