Obesity, Weight Gain, and Fluid Overload in Peritoneal Dialysis

Abstract

Obesity is a global epidemic that has a complicated pathogenesis as well as impact on the outcome of peritoneal dialysis (PD) patients. In this review, the prevalence of obesity in incident PD patients as well as the phenomenon of new-onset glucose intolerance after PD will be reviewed. Published literature on the effect of obesity on the survival and incidence of cardiovascular disease in PD patients will be discussed. Particular emphasis would be put on literature that compared the impact of obesity on the outcome of hemodialysis and PD, and the confounding effect of dialysis adequacy. Next, the complex concept of obesity and its relevance for PD will be explored. The focus would be put on the methods of assessment and clinical relevance of central versus general obesity, as well as visceral versus subcutaneous adipose tissue. The relation between obesity and systemic inflammation, as well as the biological role of several selected adipokines will be reviewed. The confounding effects of metabolic syndrome and insulin resistance will be discussed, followed by the prevalence and prognostic impact of weight gain during the first few years of PD. The differences between weight gain due to fluid overload and accumulation of adipose tissue will be discussed, followed by the current literature on the change in body composition after patients are put on chronic PD. The methods of body composition will be reviewed, and the clinical relevance of individual body component (fluid, fat, muscle, and bone) will be discussed. The review will conclude by highlighting current gaps of knowledge and further research directions in this area.

The Impact of Volume Overload on the Longitudinal Change of Adipose and Lean Tissue Mass in Incident Chinese Peritoneal Dialysis Patients

“…Notably, mean CRP became a significant predictor of lean tissue loss (beta = −0.27, p = 0.001). Interestingly, fluid overload may aggravate systemic inflammation via bacterial translocation through edematous bowel (‘the leaky gut’) [ 6 , 42 ]. In addition to the volume overload and inflammation, hyperphosphatemia was also linked to cardiovascular mortality.…”

“…Nutrition assessments in daily clinical practices typically rely on anthropometric measurements (e.g., body weight (BW) or body mass index (BMI)) and serum albumin, but these methods are not without limitations. First, an increase in BW does not help clinicians distinguish between an increase in adiposity and excessive fluid, both of which are common and frequently coexist in dialysis patients [ 4 , 5 , 6 ]. Second, although serum albumin is a well-recognized predictor of mortality in PD patients [ 7 , 8 ], its performance as nutritional index may be hampered given its close association with systemic inflammation and volume overload [ 9 ].…”

Association between sarcopenic obesity and mortality in patients on peritoneal dialysis: a prospective cohort study

“…Sarcopenia, characterized by muscle atrophy and impaired muscle function, is strongly associated with adverse clinical outcomes in dialysis patients, including worse quality of life, higher hospitalization rate and increased mortality (7,8). Similar to the trend in the general population, obesity is increasingly common in patients receiving PD (9). It has been shown that the prevalence of obesity has increased substantially after PD initiation (10).…”

Elevated Ferritin Levels Associated with High Body Fat Mass Affect Mortality in Peritoneal Dialysis Patients

“…Obesity is a common treatment-related complication of PD [7]. A large proportion of patients have experienced significant weight gain during PD treatment [8,9].…”