Excessive Weight Gain during the First Year of Peritoneal Dialysis Is Associated with Inflammation, Diabetes Mellitus, and a Rapid Decrease in Residual Renal Function.

Jwa-Kyung Kim,Sung Gyun Kim,Sung Jin Moon,Young-Su Kim,Young Rim Song,Hyung Jik Kim,Abelardo I Aguilera

doi:10.1371/journal.pone.0139033

Abstract

ObjectivesSignificant weight gain is a potential problem in most patients starting peritoneal dialysis (PD); however, few studies have explored the clinical effects of increased body weight (BW) in these patients. We evaluated the effect of excess weight gain during the first year after PD on residual renal function (RRF).MethodsA total of 148 incident PD patients were analyzed in a longitudinal observational study. The mean duration of follow-up was 23.8 months. RRF was measured at baseline (within 1 month of starting PD) and thereafter at 6-month intervals for 2–3 years or until loss of RRF. BW was measured at the time of RRF measurement, and excess weight gain was defined as a BW increase over the median value (3.0%).ResultsThe median 1-year increase in BW was 2.3kg (IQR, 1.01–4.58) or 3.0% (IQR, 1.13–5.31). The mean slope of RRF decline was –0.068 ± 0.053 mL/min/month/1.73m2, and RRF loss developed in 48 patients at a mean follow-up time of 19.4 ± 6.8 months. Patients with BW increases > 3.0% showed significantly increased RRF decline rate compared to those without excess weight gain (p<0.001), and the BW increase (%/year) correlated significantly with higher hs-CRP levels and RRF decline rate. High systolic blood pressure, diabetes, large amount of proteinuria and excess BW gain significantly influenced the RRF decline rate. Also, it increased the risk of RRF loss by 4.17-fold (95% confidence intervals, 1.87–9.28; p<0.001).ConclusionsExcess weight gain during the first year of PD was closely linked to systemic inflammation, diabetes and rapid decline in RRF.

Highlights

Patients with end-stage renal disease (ESRD) generally experience significant weight gain after initiating peritoneal dialysis (PD), and a large proportion of PD patients become obese during PD treatments [1]
We evaluated the effect of excess weight gain during the first year after PD on residual renal function (RRF)
body weight (BW) was measured at the time of RRF measurement, and excess weight gain was defined as a BW increase over the median value (3.0%)

Summary

Introduction

Patients with end-stage renal disease (ESRD) generally experience significant weight gain after initiating peritoneal dialysis (PD), and a large proportion of PD patients become obese during PD treatments [1]. Diaz-Buxo et al reported that significant body weight (BW) gain occurred during the first 17 months after initiating PD; the mean BW gain was 6.4% [2], attributable largely due to an increased caloric intake secondary to dialysate glucose absorption. A previous bioimpedance analysis (BIA) study evaluating 1-year changes in body composition found that incident PD patients experienced significant increases in total body fat and visceral fat mass. The changes were more marked than in incident hemodialysis (HD) patients. Visceral adiposity is regarded as an independent predictor of cardiovascular (CV) disease by worsening arterial stiffness and endothelial dysfunction in this population [7]. An increase in body fat mass may be a major driver of systemic inflammation and adverse long-term outcomes in PD patients [8]

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