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Xu F, Yang Y, Wu M, Zhou W, Wang D, Cui W. Patients with end-stage renal disease and diabetes had similar survival rates whether they received hemodialysis or peritoneal dialysis. Ther Apher Dial 2023; 27:59-65. [PMID: 35614543 DOI: 10.1111/1744-9987.13890] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/08/2022] [Accepted: 05/23/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND The survival rate of patients with diabetes mellitus (DM) and end-stage renal disease (ESRD) undergoing maintenance dialysis, including hemodialysis (HD) and peritoneal dialysis (PD), is markedly lower than that observed in patients with ESRD without DM. METHODS We used propensity score matching to balance the clinical characteristics of patients from the HD and PD groups. We compared the survival rate between HD or PD, followed by Cox regression analyses accounting for age, Charlson comorbidity index (CCI), body mass index (BMI), and serum albumin levels to examine the outcome influence of dialysis modalities. RESULTS During follow-up, there were 19 (18.1%) and 18 (17.1%) deaths among patients who underwent HD and PD, respectively (P = 0.856). Kaplan-Meier survival analyses showed no significant difference in overall survival between patients in the HD and PD groups. Cox regression analyses stratified based on age, CCI, BMI, and serum albumin demonstrated that the choice of HD over PD did not influence survival. CONCLUSIONS Regardless of age, CCI, BMI, and albumin level, patients with DM and ESRD had similar survival rates whether they received HD or PD in China. The choice of dialysis modality should be individualized according to patients' physical status and local practices for patients with DM and ESRD.
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Affiliation(s)
- Feng Xu
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, China
| | - Yue Yang
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, China
| | - Man Wu
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, China
| | - Wenhua Zhou
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, China
| | - Dongxue Wang
- Department of Pharmacy, The Second Hospital of Jilin University, Changchun, China
| | - Wenpeng Cui
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, China
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Ng JKC, Than WH, Szeto CC. Obesity, Weight Gain, and Fluid Overload in Peritoneal Dialysis. FRONTIERS IN NEPHROLOGY 2022; 2:880097. [PMID: 37675033 PMCID: PMC10479638 DOI: 10.3389/fneph.2022.880097] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/02/2022] [Indexed: 09/08/2023]
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.
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Affiliation(s)
- Jack Kit-Chung Ng
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Win Hlaing Than
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Li Ka Shing Institute of Health Sciences (LiHS), Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Cheuk Chun Szeto
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Li Ka Shing Institute of Health Sciences (LiHS), Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
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Afghahi H, Nasic S, Peters B, Rydell H, Hadimeri H, Svensson J. Long-term glycemic variability and the risk of mortality in diabetic patients receiving peritoneal dialysis. PLoS One 2022; 17:e0262880. [PMID: 35077471 PMCID: PMC8789125 DOI: 10.1371/journal.pone.0262880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 01/10/2022] [Indexed: 11/18/2022] Open
Abstract
Background
The large amount of glucose in the dialysate used in peritoneal dialysis (PD) likely affects the glycemic control. The aim of this study was to investigate the association between HbA1c variability, as a measure of long-term glycemic variability, and the risk of all-cause mortality in diabetic patients with PD.
Methods
325 patients with diabetes and ESRD were followed (2008–2018) in the Swedish Renal Registry. Patients were separated in seven groups according to level of HbA1c variability. The group with the lowest variability was denoted the reference. The ratio of the standard deviation (SD) to the mean of HbA1c, HbA1c (SD)/HbA1c (mean), i.e. the coefficient of variation (CV), was defined as HbA1c variability. Hazard ratios (HR) and 95% confidence intervals (CI) were examined using Cox regression analyses.
Results
During follow-up, 170 (52%) deaths occurred. The highest mortality was among patients with the second highest HbA1c variability, CV≥2.83 [n = 44 of which 68% patients died]. In the multivariate analyses where lowest HbA1c variability (CV≤0.51) was used as the reference group, HbA1c CV 2.83–4.60 (HR 3.15, 95% CI 1.78–5.55; p<0.001) and CV> 4.6 (HR 2.48, 95% CI 1.21–5.11; p = 0.014) were associated with increased risk of death.
Conclusion
The high risk of all-cause mortality in patients with diabetes and PD increased significantly with elevated HbA1c variability, as measure of long-term glycemic control. This indicates that stable glycemia is associated with an improvement of survival; whereas more severe glycemic fluctuations, possibly caused by radical changes in dialysis regimes or peritonitis, are associated with a higher risk of mortality in diabetic patients with PD.
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Affiliation(s)
- Hanri Afghahi
- Department of Nephrology, Skaraborg Hospital, Skövde, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Salmir Nasic
- Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Research and Development Center at Skaraborg Hospital, Skövde, Sweden
| | - Björn Peters
- Department of Nephrology, Skaraborg Hospital, Skövde, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- * E-mail:
| | - Helena Rydell
- Division of Renal Medicine, Department of Clinical Sciences Intervention and Technology, Karolinska Institute, Stockholm, Sweden
- Department of Internal Medicine, Swedish Renal Registry, Ryhov Regional Hospital, Jönköping, Sweden
| | - Henrik Hadimeri
- Department of Nephrology, Skaraborg Hospital, Skövde, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Johan Svensson
- Research and Development Center at Skaraborg Hospital, Skövde, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Elezi B, Topi S, Abazaj E. Profile of Obesity and Comorbidities and their Correlation among Hemodialysis Patients, Elbasan. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.7519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION: Nowadays, obesity is an enormous problem in the public health of undeveloped countries and developing countries. Being overweight, especially obesity in internal organs contributes to increased risk of metabolic and cardiovascular complications in patients with chronic kidney disease. There is no complete data available in our country on the correlation between obesity and comorbidity diseases among persons undergoing dialysis. So we do not know how BMI affects Diabetic or Cardio Vascular Disease (CVD) patients among dialysis patients. We, therefore, undertook this study to evaluate the association of obesity with mobility in hemodialysis patients at the Elbasan dialysis center.
METHODOLOGY: This cross-sectional study was performed in 160 patients who have undergone the dialysis process at Elbasan Dialysis Center for three years (2016-2018). A standardized questionnaire was adopted to obtain data from all patients. The subjects were divided a priory into 4 categories based on the body mass index (BMI) (underweight <19, normal 19-25, pre-obese 25-30 and obese ≥30 kg/m2). Software SPSS version 20.0 is used to analyze and evaluate the data. Kaplan-Meier estimate were used to find the correlation between BMI with their prognostic abilities like cardiovascular disease and Diabetes Mellitus Type 2. We have considered statistically significant every p value less than 0.05.
RESULT: Over all 160 patients, the men presented the highest number of cases compared to female 73.1% and 26.9% respectively. The mean age resulted 52.7 ± 15.6 years and age groups 50-59 years old and 60-69 years old with 29.4% and 34.3% respectively were the most frequent in this study. About the category of BMI index 8.8% patients resulted underweight, 45% were in normal weight, 28.2% were pre-obese and 6.6% were obese. We observed significant correlations between BMI and some of the demographic data such as: gender, age, place of residence, educational level, smoking and alcohol consumption for p <0.05. Changes in patient survival rates between BMI with DMT2 and cardiovascular disease are not statistically significant (long range p> 0.05). In terms of mortality, a strong significant correlation was observed with the age of 50-69 years and with the index of hemoglobin, urea and creatinine after dialysis with p value <0.05.
CONCLUSION: In the paradoxical epidemiology, the overweight becomes chronic on hemodialysis patients and serves as a protective factor which is associated with better survival, but we weren`t found significant association between the BMI and some of the variables analyzed. This study presents a small number of chronic patients on hemodialysis center in Elbasan city. There is a need to better understand the reverse epidemiological causes in individuals on dialysis, which can help us improve the poor outcome in this population.
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Than WH, Ng JKC, Chan GCK, Fung WWS, Chow KM, Szeto CC. The change in the prevalence of obesity and new-onset diabetes in Chinese peritoneal dialysis patients over 25 years. Clin Kidney J 2022; 15:70-78. [PMID: 35035938 PMCID: PMC8757419 DOI: 10.1093/ckj/sfab139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Indexed: 11/29/2022] Open
Abstract
Background The global prevalence of both obesity and end-stage kidney diseases (ESKDs) has increased in recent decades. Given the complicated interaction between obesity and ESKD, we examined the change in the prevalence of obesity in incident Chinese peritoneal dialysis (PD) patients over the past 25 years. Methods We reviewed the anthropometric measures of incident PD patients in a single Hong Kong center from 1995 to 2019. The results are reported in five 5-year periods. Patients with and without diabetes were analyzed separately, and the incidence of new-onset diabetes after PD was explored. Results We reviewed 1681 patients. Their mean age was 58.4 ± 12.5 years; 931 patients (55.4%) had pre-existing diabetes. From 1995–99 to 2015–19, the prevalence of obesity or overweight at the initiation of PD increased progressively for every 5-year period (from 21.9% to 26.2, 37.9, 42.7 and 47.3%, P < 0.001 for linearity). The increase in the prevalence of obesity or overweight was more pronounced in diabetic patients (from 33.7% to 59.6%) than non-diabetic ones (from 13.2% to 32.3%). Among nondiabetics patients, the incidence of new-onset diabetes after started on PD showed an insignificant rising trend during that period (from 18.0, 19.7, 17.8 and 22.4% to 23.3%, P = 0.106). The incidence of new-onset impaired fasting glucose or diabetes was significantly higher in obese or overweight patients than the others (56.9% versus 51.4%, P < 0.001). Conclusions The prevalence of obesity has increased substantially in both diabetic and nondiabetic new PD patients in Hong Kong over the past 25 years. The incidence of new-onset diabetes was significantly higher in new PD patients with pre-existing obesity or overweight than those without obesity. The prognostic implication and impacts on the healthcare system deserve further studies.
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Affiliation(s)
- Win Hlaing Than
- Department of Medicine & Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Jack Kit-Chung Ng
- Department of Medicine & Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Gordon Chun-Kau Chan
- Department of Medicine & Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Winston Wing-Shing Fung
- Department of Medicine & Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Kai-Ming Chow
- Department of Medicine & Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Cheuk-Chun Szeto
- Department of Medicine & Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, Shatin, Hong Kong, China
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Diwan TS, Cuffy MC, Linares-Cervantes I, Govil A. Impact of obesity on dialysis and transplant and its management. Semin Dial 2020; 33:279-285. [PMID: 32277512 DOI: 10.1111/sdi.12876] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Obesity is increasing to unprecedented levels, including in the end-stage kidney disease population, where upwards of 60% of kidney transplant patients are overweight or obese. Obesity poses additional challenges to the care of the dialysis patient, including difficulties in creating vascular access and inserting Tenckhoff catheters, higher rates of catheter malfunction and peritonitis, the need for longer and/or more frequent dialysis (or peritoneal dialysis [PD] exchanges) to achieve adequate clearance, increased metabolic complications particularly with PD, and obesity is a barrier to kidney transplantation. In this article, we review special considerations in performing PD, hemodialysis and transplant in the obese patient, as well as the evidence behind medical and surgical management of obesity in dialysis patients.
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Affiliation(s)
- Tayyab S Diwan
- Division of Transplantation, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Madison C Cuffy
- Division of Transplantation, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Ivan Linares-Cervantes
- Division of Transplantation, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Amit Govil
- Division of Nephrology, Department of Medicine, University of Cincinnati, Cincinnati, OH, USA
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Hwang SD, Lee JH, Jhee JH, Song JH, Kim JK, Lee SW. Impact of body mass index on survival in patients undergoing peritoneal dialysis: Analysis of data from the Insan Memorial End-Stage Renal Disease Registry of Korea (1985-2014). Kidney Res Clin Pract 2019; 38:239-249. [PMID: 31096315 PMCID: PMC6577214 DOI: 10.23876/j.krcp.18.0106] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 12/30/2018] [Accepted: 01/22/2019] [Indexed: 12/11/2022] Open
Abstract
Background Significant increases in the prevalence of obesity have been observed among patients with peritoneal dialysis (PD). The impact of body mass index (BMI) on survival remains unknown in Korean PD patients. Methods Among data of 80,674 patients on PD acquired from the Insan Memorial ESRD Registry database for the years 1985 to 2014, 6,071 cases were analyzed. Subjects were classified by baseline BMI; < 21.19 kg/m2 (quartile 1, n = 1,518), 21.19 to 23.18 kg/m2 (quartile 2, reference; n = 1,453), 23.19 to 25.71 kg/m2 (quartile 3, n = 1,583), and > 25.71 kg/m2 (quartile 4, n = 1,517). Results Mean age was 65.8 years, and baseline BMI was 23.57 kg/m2. Numbers of male and diabetic patients were 3,492 (57.5%) and 2,192 (36.1%), respectively. Among 6,071 cases, 2,229 (36.7%) all-cause deaths occurred. As a whole, Kaplan–Meier survival curves according to BMI quartiles was significantly different (P = 0.001). All-cause mortality was significantly higher in quartile 4 than in the reference (hazard ratio [HR] = 1.154, 95% confidence interval [CI], 1.025–1.300; P = 0.018). There was no statistical difference in all-cause mortality among BMI quartiles in diabetic patients on PD. In non-diabetic patients, all-cause mortality of quartiles 1 and 3 was not different from the reference, but the HR was 1.176 times higher in quartile 4 (95% CI, 1.024–1.350; P = 0.022). Conclusion Baseline BMI > 25.71 kg/m2 seems to be an important risk factor for all-cause mortality in Korean PD patients.
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Affiliation(s)
- Seun Deuk Hwang
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Jin Ho Lee
- Division of Nephrology, Department of Internal Medicine, Bong Seng Memorial Hospital, Busan, Korea
| | - Jong Hyun Jhee
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Joon Ho Song
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Joong Kyung Kim
- Division of Nephrology, Department of Internal Medicine, Bong Seng Memorial Hospital, Busan, Korea
| | - Seoung Woo Lee
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
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Affiliation(s)
- Emilie Trinh
- Division of Nephrology; McGill University Health Center; Montreal QC Canada
| | | | - Jeffrey Perl
- Division of Nephrology; St. Michael's Hospital and the Keenan Research Center in the Li Ka Shing Knowledge Institute; St. Michael's Hospital; Toronto ON Canada
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