Abstract
Although high body mass index (BMI) appears to confer a survival advantage in hemodialysis patients, the association of BMI with mortality in continuous ambulatory peritoneal dialysis (CAPD) patients is uncertain. We enrolled incident CAPD patients and BMI was categorized according to World Health Organization classification for Asian population. BMI at baseline and one year after the initiation of peritoneal dialysis (PD) treatment was assessed to calculate the BMI change (∆BMI). Patients were split into four categories according quartiles of ∆BMI. Kaplan-Meier method and Cox regression proportional hazard analysis were performed to assess the association of BMI on outcomes. A total of 1263 CAPD patients were included, with a mean age of 47.8 ± 15.0 years, a mean BMI of 21.58 ± 3.13 kg/m2. During a median follow-up of 25.3 months, obesity was associated with increased risk for cardiovascular diseases (CVD) death (adjusted hazard ratio (AHR) 2.01; 95% CI 1.14, 3.54), but not all-cause mortality. Additionally, patients with more BMI decline (>0.80%) during the first year after CAPD initiation had an elevated risk for both all-cause (AHR: 2.21, 95% CI 1.23–3.95) and CVD mortality (AHR 2.31, 95% CI 1.11, 4.84), which was independent of baseline BMI values.
Highlights
The World Health Organization (WHO) body mass index (BMI) categories of overweight and obesity are increasing globally
Many studies indicate that a high BMI is an independent risk factor for morbidity and mortality from cardiovascular disease (CVD) and certain cancers in the general population [1,2,3,4], and elevates the risk for chronic kidney disease (CKD) as well as its progression to end-stage renal disease (ESRD) [5,6,7]
There was a trend towards higher levels of TG, high sensitive C-reactive protein (hs-CRP), and residual glomerular filtration rate (rGFR) with increased BMI values, whereas BMI categories were inversely related to total Kt/Vurea (p < 0.001)
Summary
The World Health Organization (WHO) body mass index (BMI) categories of overweight and obesity are increasing globally. In contrast to the general population, an increased BMI is correlated with better outcomes in both prevalent and incident hemodialysis (HD) patients, including a lower risk of cardiovascular and all-cause mortality [8,9,10,11]. This “reverse epidemiology” or “paradoxical link” is controversial in peritoneal dialysis (PD) patients [12,13,14,15,16,17]. We conducted a retrospective cohort study to evaluate the association of BMI at the time of PD initiation and BMI change during the first year of PD therapy with mortality risk in Chinese CAPD patients
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