Interaction between central obesity and frailty on the clinical outcome of peritoneal dialysis patients.

Gordon Chun-Kau Chan,Vickie Wai-Ki Kwong,Cheuk Chun Szeto,Kai-Ming Chow,Philip Kam-Tao L I,Jack Kit-Chung N G,Wing-Fai Pang,Phyllis Mei-Shan Cheng,Chi-Bon Leung,Man-Ching Law,Frank Jmf Dor

doi:10.1371/journal.pone.0241242

Abstract

Frailty and obesity contribute to the adverse clinical outcome of peritoneal dialysis (PD) patients, but the interaction between frailty and obesity remains uncertain. To examine the interaction between frailty and obesity on the clinical outcome of PD patients. Single centre prospective observational cohort study. 267 prevalent Chinese PD patients were recruited. Frailty was identified by a standard score. General and central obesity were determined by body mass index (BMI) and waist-hip ratio (WHR), respectively. Body composition was assessed by bioimpedance spectroscopy. All patients were followed for two years. Outcome measures included all-cause as well as cardiovascular mortality and hospitalization. Of the 267 patients, 120 (44.9%) were frail. Frail individuals were more likely to have central obesity (p < 0.001) but not general obesity. Although WHR did not predict patient survival, there was a significant interaction between WHR and frailty on patient survival and cardiovascular survival (p = 0.002 and p = 0.038, respectively). For patients without frailty, the two-year cardiovascular survival was 91.3% and 74.4% for those with and without central obesity, respectively (p = 0.002). For patients with frailty, however, the two-year cardiovascular survival was 64.6% and 66.7% for those with and without central obesity, respectively (p = 0.6). For patients without frailty, the number of hospital admission for cardiovascular disease over 2 years were 0.12 ± 0.37 and 0.34 ± 0.72 for those with and without central obesity, respectively (p = 0.03). For frail patients, however, the number of hospital admission was similar between those with and without central obesity. There is a significant interaction between frailty and central obesity on the outcome of PD patients. The protective role of central obesity is only apparent in PD patients without frailty but not the frail ones, and there is a little prognostic value of general (non-central) obesity.

Highlights

BackgroundFrailty is described by Fried et al [1] as a clinical syndrome involving at least three of the following features: unintentional weight loss (10 lbs in one year), self-reported exhaustion, weakness, slow walking speed, and low physical activity
There is a significant interaction between frailty and central obesity on the outcome of peritoneal dialysis (PD) patients
The protective role of central obesity is only apparent in PD patients without frailty but not the frail ones, and there is a little prognostic value of general obesity

Summary

Introduction

Frailty is described by Fried et al [1] as a clinical syndrome involving at least three of the following features: unintentional weight loss (10 lbs in one year), self-reported exhaustion, weakness (as determined by grip strength), slow walking speed, and low physical activity. It is highly prevalent among patients on dialysis, with a prevalence of up to 67.7% in previous report [2]. Frail peritoneal dialysis (PD) patients have a higher hospitalization risk and their hospital stay tends to be prolonged [3]. Frailty and obesity contribute to the adverse clinical outcome of peritoneal dialysis (PD) patients, but the interaction between frailty and obesity remains uncertain

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