The change in the prevalence of obesity and new-onset diabetes in Chinese peritoneal dialysis patients over 25 years

Abstract

Background The global prevalence of both obesity and end stage kidney diseases (ESKD) increased in the past decades. With that complicated interaction between obesity and ESKD, we examined the change in the prevalence of obesity in incident Chinese peritoneal dialysis (PD) patients over the past 25 years. Methods We reviewed the anthropometric measures of incident PD patients in a single Hong Kong center from 1995 to 2019. The results are reported in five 5-year periods. Patients with and without diabetes were analyzed separately, and the incidence of new-onset diabetes after PD was explored. Results We reviewed 1681 patients. Their mean age was 58.4 ± 12.5 years; 931 patients (55.4%) had pre-existing diabetes. From 1995-1999 to 2015-2019, the prevalence of obesity or overweight at the initiation of PD increased progressively for every 5-year period (from 21.9% to 26.2%, 37.9%, 42.7% and 47.3%, p < 0.001 for linearity). The increase in the prevalence of obesity or overweight was more pronounced in diabetic patients (from 33.7% to 59.6%) than non-diabetic ones (from 13.2% to 32.3%). Among non-diabetics patients, the incidence of new-onset diabetes after started on PD showed an insignificant rising trend during that period (from 18.0%, 19.7%, 17.8%, 22.4%, to 23.3%, p = 0.106). The incidence of new-onset impaired fasting glucose or diabetes was significantly higher in obese or overweight patients than the others (56.9% vs 51.4%, p < 0.001). Conclusion The prevalence of obesity increase substantially in both diabetic and non-diabetic new PD patients in Hong Kong over the past 25 years. The incidence of new-onset diabetes was significantly higher in new PD patients with pre-existing obesity or overweight than those without obesity. The prognostic implication and impacts on the healthcare system deserve further studies.

Adipose and serum zinc alpha-2-glycoprotein (ZAG) expressions predict longitudinal change of adiposity, wasting and predict survival in dialysis patients

“…Indeed, our dialysis patients gained a sizable amount of weight after dialysis initiation, which is predominantly contributed by fat mass gain, rather than lean tissue mass gain or overhydration. Such finding is in concordant with previous studies 29 – 31 , and this problem tends to be more apparent at the start of dialysis 30 . While diabetes mellitus, peritoneal dialysate glucose absorption 1 predicted fat gain in peritoneal dialysis patients, we extend the understanding by illustrating adipose ZAG accelerated the process of adipose mass acquisition.…”

Obesity, Weight Gain, and Fluid Overload in Peritoneal Dialysis

“…In this study, the prevalence of obesity or overweight at the initiation of PD increased from 21.9% before 2000 to 47.3% after 2015 (22). Notably, the absolute increase in the prevalence of obesity or overweight was more pronounced in diabetic patients (from 33.7% to 59.6%) than non-diabetic ones (from 13.2% to 32.3%), although the relative increase was actually more marked in the non-diabetic group (22). However, the prevalence of obesity as well as the magnitude of its increase was slightly lower among PD patients than that observed in the general population (21), which is probably the result of the common coexistence of protein-energy malnutrition in patients with advanced CKD (23,24).…”

“…Following the trend in the general population (17)(18)(19)(20)(21), obesity is increasingly common among incident PD patients. In a retrospective study of 1681 incident adult PD patients from a single center, Than et al (22) reported that 37.7% were obese or overweight at the initiation of PD over a 25 years period of observation. In this study, the prevalence of obesity or overweight at the initiation of PD increased from 21.9% before 2000 to 47.3% after 2015 (22).…”

“…In a retrospective study of 1681 incident adult PD patients from a single center, Than et al (22) reported that 37.7% were obese or overweight at the initiation of PD over a 25 years period of observation. In this study, the prevalence of obesity or overweight at the initiation of PD increased from 21.9% before 2000 to 47.3% after 2015 (22). Notably, the absolute increase in the prevalence of obesity or overweight was more pronounced in diabetic patients (from 33.7% to 59.6%) than non-diabetic ones (from 13.2% to 32.3%), although the relative increase was actually more marked in the non-diabetic group (22).…”

“…In a recent analysis of 1681 incident PD patients, Than et al (22) noted that the fasting plasma glucose level after initiation of PD in patients without pre-existing diabetes rose gradually from 5.9 ± 2.0 to 6.4 ± 2.2 mmol/l from 1995 to 2019, and the incidence of new-onset diabetes increased from 18.0% to 23.3% during this period (22). In this study, there was a modest but statistically significant correlation between post-dialysis fasting plasma glucose level and baseline BMI in non-diabetic patients; new-onset diabetes was present in 37.9% patients with baseline BMI 19.0 to 23.9 kg/ m2, but 59.0% of those with baseline BMI above 25.0 kg/m2 (22).…”