Weight change during the first year of peritoneal dialysis: Risk factors and prognostic implications

Choy, Agnes Shin-Man; Chow, Kai‐Ming; Kwan, Bonnie Ching-Ha; Cheng, Phyllis Mei-Shan; Kwong, Vickie Wai‐Ki; Pang, Wing‐Fai; Leung, Chi‐Bon; Law, Man-Ching; Li, Philip Kam-Tao; Szeto, Cheuk‐Chun

doi:10.1016/j.hkjn.2015.08.001

Cited by 8 publications

(8 citation statements)

References 28 publications

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“…Taken together, these data indicate that improvement in uremia and general health is the more important cause of weight gain, while glucose absorption from the PD solution plays only a minor role. Consistent with this notion, weight gain during the first year of PD in this study was not associated with adverse clinical outcome in the subsequent follow up, while weight loss during the first year of PD predicted poor patient survival (35). Similarly, analysis of 1911 adult incident PD patients recruited from 114 dialysis centers that participated in the Brazilian Peritoneal Dialysis Multicenter Cohort Study, Fernandes et al (38) found that weight gain during the first year of PD was not associated with a higher subsequent mortality.…”

Section: Weight Gain During Pdsupporting

confidence: 85%

“…Nonetheless, previous studies that compared the magnitude of the weight gain after the initiation of dialysis showed either no significant difference in the change in body weight after started on PD or hemodialysis, or actually a slightly higher probability of substantial weight gain after started on hemodialysis (36,37). In the study of Choy et al (35), there were no significant correlations between body weight gain and glucose load or peritoneal transport parameters, but patients without any peritonitis episodes during the first year of PD had significantly more weight gain than patients who experienced peritonitis during that time (35). Taken together, these data indicate that improvement in uremia and general health is the more important cause of weight gain, while glucose absorption from the PD solution plays only a minor role.…”

Section: Weight Gain During Pdmentioning

confidence: 92%

“…Not only that obesity is common in incident PD patients, a large proportion of PD patients have substantial weight gain after the initiation of PD (32)(33)(34). In a study of 444 consecutive incident PD patients, Choy et al (35) found that the mean weight gain after one year of PD was 1.34 kg, and nearly 25% patients had weight gain over 3 kg. Nonetheless, previous studies that compared the magnitude of the weight gain after the initiation of dialysis showed either no significant difference in the change in body weight after started on PD or hemodialysis, or actually a slightly higher probability of substantial weight gain after started on hemodialysis (36,37).…”

Section: Weight Gain During Pdmentioning

confidence: 99%

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Obesity, Weight Gain, and Fluid Overload in Peritoneal Dialysis

Than

Szeto

2022

Front. Nephrol.

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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.

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Section: Weight Gain During Pdsupporting

confidence: 85%

Section: Weight Gain During Pdmentioning

confidence: 92%

Section: Weight Gain During Pdmentioning

confidence: 99%

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Obesity, Weight Gain, and Fluid Overload in Peritoneal Dialysis

Than

Szeto

2022

Front. Nephrol.

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“…Even still, the majority of PD patient cases experience a significant gain in body weight [29]. The presence of weight loss in the first year is associated with adverse results [30,31]. One limitation for the assessment of this parameter is the fluid gain that can mask weight loss [27].…”

Section: Body Massmentioning

confidence: 99%

Diagnosis, Prevention, and Treatment of Protein-Energy Wasting in Peritoneal Dialysis

Yanowsky-Escatell¹,

Pazarín-Villaseñor²,

Andrade‐Sierra³

et al. 2018

Evolving Strategies in Peritoneal Dialysis

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Protein-energy wasting (PEW) is highly prevalent in peritoneal dialysis (PD) patients and is associated with mortality. Reduced protein and energy intake, comorbidity conditions, endocrine disorders, increased inflammatory cytokines, uremic toxins, metabolic acidosis, oxidative stress, nutrient losses into dialysate, continuous absorption of glucose from PD solutions, abdominal fullness induced by the dialysate, and peritonitis contribute to PEW. Assessment of nutritional status for the detection and management of PEW includes the PEW definition criteria, subjective global assessment (SGA), malnutrition-inflammation score (MIS), and geriatric nutritional risk index (GNRI). Diverse factors can affect nutritional and metabolic status in these patients so multiple strategies may be required to prevent or reverse PEW. Preventive measures include continuous nutritional counseling, optimizing dietary nutrient intake, and managing comorbidities. To treat PEW, the following may be used: administration of oral, intraperitoneal, enteral, or parenteral nutritional supplementation and adjunct therapies such as anabolic agents, appetite stimulants, antiinflammatory interventions, and exercise. Diagnosis, prevention, and treatment of PEW in PD patients may favorably impact the prognosis and course of the disease.

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“…To complicate the matter, patients tend to gain weight after started on PD, presumably due to the improvement in appetite and glucose load in PD solutions [8, 9]. A previous study at our center showed that the mean weight gain after the first year of PD was 1.3 kg and around 25% patients had weight gain over 3 kg [10].…”

Section: Introductionmentioning

confidence: 99%

Impact of Weight Gain on the Subsequent Survival of New Peritoneal Dialysis Patients

Than¹,

Ng²,

Chan³

et al. 2023

Kidney Dis

Self Cite

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Introduction: Obesity at the initiation of dialysis was reported to adversely affect the clinical outcome of peritoneal dialysis (PD) patients, and weight gain is common after started on PD. However, there are few studies on the prognostic implications of weight gain after PD. Methods: We reviewed the change in body weight of 954 consecutive patients during the first 2 years of PD in a single Hong Kong center. Their subsequent clinical outcomes, including patient and technique survival rates, hospitalization, and peritonitis rates, were analyzed. Results: The mean age was 60.3 ± 12.2 years; 535 patients (56.1%) were men, and 504 (52.8%) had diabetes. From 1995-1999 to 2015-2019, the percentage of body weight gain during the first 2 years of PD was 1.0 ± 7.9%, 1.6 ± 7.1%, 1.6 ± 7.2%, 3.9 ± 9.5%, to 4.0 ± 10.3% for each 5-year period, respectively (p for linearity <0.0001). The subsequent 5-year patient survival rates were 29.9%, 43.3%, 40.5%, 43.6%, and 43.3% for patients with weight loss >5%, weight loss 2-5%, weight change with 2%, weight gain 2-5%, and weight gain >5% during the first 2 years on PD, respectively (log-rank test, p = 0.035). With multi-variable Cox regression model to adjust for clinical confounders, weight loss >5% during the first 2 years of PD was associated with a worse patient survival rate subsequently (adjusted hazard ratio 4.118, 95% confidence interval 1.040-16.313, p = 0.044), while weight gain was not associated with the subsequent patient survival. Weight change during the first 2 years of PD does not appear to affect subsequent technique survival, hospitalization, decline in residual renal function, or peritonitis rate. Discussion and Conclusions: Weight gain is common during the first two years of PD, but weight gain does not appear to have any significant impact on the subsequent outcome. In contrast, weight loss >5% was significantly associated a worse patient survival subsequently.

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Weight change during the first year of peritoneal dialysis: Risk factors and prognostic implications

Cited by 8 publications

References 28 publications

Obesity, Weight Gain, and Fluid Overload in Peritoneal Dialysis

Obesity, Weight Gain, and Fluid Overload in Peritoneal Dialysis

Diagnosis, Prevention, and Treatment of Protein-Energy Wasting in Peritoneal Dialysis

Impact of Weight Gain on the Subsequent Survival of New Peritoneal Dialysis Patients

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