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

Abstract

Background Frailty and obesity contribute to the adverse clinical outcome of peritoneal dialysis (PD) patients, but the interaction between frailty and obesity remains uncertain. Objective To examine the interaction between frailty and obesity on the clinical outcome of PD patients. Design Single centre prospective observational cohort study. Patients 267 prevalent Chinese PD patients were recruited. Measurements 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. Results 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. Conclusion 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.

Urinary 8-OxoGsn as a Potential Indicator of Mild Cognitive Impairment in Frail Patients With Cardiovascular Disease

“…One possible reason for this inconsistency may be that we excluded patients with dementia from our study, and only patients with mild cognitive decline were enrolled, and thus there was an insufficient number of cases with CVD to detect early changes in cognitive function. Second, previous studies have found that some forms of CVD and risk factors, such as heart failure ( Yao et al, 2020 ), coronary artery disease ( Ma et al, 2020 ), stroke ( Chumha et al, 2020 ), atrial fibrillation ( Guo et al, 2020 ), and obesity ( Chan et al, 2020 ), are significantly associated with frailty, thus the relationship between CVDs or risk factors and MCI may be weakened in frail patients. Further research on CVDs and MCI in frail patients should be performed in the future.…”

Urinary 8-OxoGsn as A Potential Indicator of Mild Cognitive Impairment in Frail Patients With Cardiovascular Disease

“…One possible reason for this inconsistency may be that we excluded patients with AD from our study, and only patients with mild cognitive decline were enrolled, and thus there was an insu cient number of cases with CVDs to detect early changes in cognitive function. Second, previous studies have found that some CVDs and risk factors, such as heart failure[38], coronary artery disease [39], stroke [40], atrial brillation [41], and obesity [42], are signi cantly associated with frailty, thus the relationship between CVDs and MCI may be weakened in frail patients. Further research on CVDs and MCI in frail patients should be performed in the future.…”

Obesity, Weight Gain, and Fluid Overload in Peritoneal Dialysis

“…There are recent data to further show that the prognostic impact of obesity is affected by the coexistence of frailty. In a study of 267 prevalent Chinese PD patients, Chan et al (60) noted that frail patients had a higher waist-hip ratio (an indicator of central obesity) but not BMI. Although waist-hip ratio did not predict patient survival in this study, there was a significant interaction between waist-hip ratio and frailty on patient survival and cardiovascular survival (60).…”

“…In a study of 267 prevalent Chinese PD patients, Chan et al (60) noted that frail patients had a higher waist-hip ratio (an indicator of central obesity) but not BMI. Although waist-hip ratio did not predict patient survival in this study, there was a significant interaction between waist-hip ratio and frailty on patient survival and cardiovascular survival (60). For patients without frailty, the two-year cardiovascular survival was significantly better for those with a high waist-hip ratio (91.3% versus 74.4%), and they had fewer hospital admission for cardiovascular disease in 2 years, while waist-hip ratio did not predict the cardiovascular survival or need of hospital admission for cardiovascular disease in frail patients (60).…”