Increase of Intra-Abdominal Fat in Patients Treated with Continuous Ambulatory Peritoneal Dialysis

Abstract

Objective To evaluate changes in amount and distribution of body fat in patients treated with continuous ambulatory peritoneal dialysis (CAPD). Design Prospective study. Computed tomography (CT) and dual energy x-ray absorptiometry (DEXA) were used for determination of body composition at commencement of CAPD, and after a mean of 7.2 months of dialysis treatment. Setting CAPD unit at an academic teaching hospital. Patients The study included 19 consecutive patients who started CAPD during a 15-month time frame. Of these 19 patients, 12 (8 males) with a mean initial age of 60 years completed the study. Main Outcome Measures Siemens Somatom HiQ (Erlangen, Germany) was used for CT of the abdomen and of the right thigh. Fat and muscle areas were expressed as square centimeters. The proportion of total fat mass was determined by body composition analysis using DEXA (DPX-L densitometer) (Lunar, Madison, WI, U.S.A.) and expressed as percentage of total body weight (FAT%). Results Body weight changed from 67.1 to 68.4 kg (p = 0.20), and the intra-abdominal fat area increased 22.8% (p = 0.02). This increase was predominantly seen in male patients (p = 0.007). The FAT% changed from 27.8% to 30.9% (p = 0.25), without difference between sexes. Conclusion The increase of intra-abdominal fat found in this study may suggest a mechanism by which the established risk for CAPD patients to develop cardiovascular morbidity and mortality may be at least partially explained.

Waist circumference as a predictor of mortality in peritoneal dialysis patients: a follow-up study of 48 months

“…And, more importantly, we showed that changes over time in WC were associated with higher mortality in these patients. The current finding is relevant as available data show that PD patients accumulate body fat over time, particularly in the abdominal area (17,18) . In fact, Fernstrom et al (17) showed that visceral fat, measured by computed tomography, increased substantially in a sample of incident PD patients followed up for 15 months.…”

“…The current finding is relevant as available data show that PD patients accumulate body fat over time, particularly in the abdominal area (17,18) . In fact, Fernstrom et al (17) showed that visceral fat, measured by computed tomography, increased substantially in a sample of incident PD patients followed up for 15 months. In addition, a subsequent investigation including sixty patients demonstrated that both visceral and subcutaneous fat increased during the first 6 months on PD therapy (18) .…”

“…Body-fat gain is a common finding among peritoneal dialysis (PD) patients, particularly after commencing dialysis therapy (11)(12)(13)(14)(15)(16) . Further, there is evidence that the accumulation of body fat occurs predominantly in the abdominal area (17,18) . However, the impact of abdominal obesity on clinical outcomes has been scarcely investigated among patients undergoing PD (19,20) .…”

Fat tissue and inflammation in patients undergoing peritoneal dialysis

“…Patients undergoing peritoneal dialysis (PD) gain weight during at least the first months of treatment, mainly due to an increase in intra-abdominal fat [ 4 ]. However, survival studies in PD patients are controversial [ 5 ].…”

Glucose-Based Peritoneal dialysis solution suppresses adiponectin synthesis through oxidative stress in an experimental model of peritoneal dialysis

“…♦ Conclusions: Our data suggest that ROS induced by con ventional glucosebased PDS may contribute to pathophysi ological changes in abdominal fat and down regulate adi ponectin secreted from adipocytes during longterm PD. P eritoneal dialysis (PD) patients are characterized by accumulation of intra-abdominal fat (1,2). Studies have highlighted that visceral adipose tissue produces large amounts of proinflammatory cytokines, such as interleukin-6, which in turn are linked to increased incidence of cardiovascular disease (CVD) and death (3,4).…”