The association between body mass index and mortality among Asian peritoneal dialysis patients: A meta-analysis

The relationship between body mass index changes and mortality in geriatric peritoneal dialysis patients: a case-control study

BACKGROUND

The prevalence of chronic kidney disease (CKD) is increasing, reflecting the rising incidence of chronic diseases. With the continuous growth of the global geriatric population, a significant portion of individuals with CKD consists of those aged over 65. Regardless of the chosen treatment method, protein-energy loss in patients undergoing renal replacement therapy (RRT) has been associated with elevated morbidity and mortality rates.

METHODS

This is a retrospective, single-center study of incident adult PD patients on peritoneal dialysis (PD) from 1998 to 2022. We aimed to compare the survival outcomes of geriatric patients on PD with changing BMI measurements.

RESULTS

In the geriatric patient group exhibiting a reduced BMI after dialysis initiation, BMI significantly and negatively influenced survival (p = 0.01). The negative effect of BMI on survival was independent of known risk factors such as diabetes mellitus, a history of cardiovascular disease, gender, residual renal function, and history of hemodialysis before peritoneal dialysis (HD before PD) (p = 0.04).

CONCLUSION

Although BMI is easy and extensively measured, it is not considered the perfect monitoring parameter for dialysis patients. However, regular follow-up of BMI, especially in geriatric cases, can be a guiding tool for estimating patients' prognoses.

Incidence of major cardiovascular events at 1, 2, and 5 years and mortality in incident patients on peritoneal dialysis regarding their nutritional status by bioimpedanciometry: A multicenter study in Colombia

BACKGROUND

The nutritional status of incident patients on peritoneal dialysis (PD) has been associated with survival outcomes. Bioimpedanciometry (BCM) enables to establish a nutritional diagnosis, the volume status, and correlates these findings with survival.

METHODS

This study used a retrospective multicenter historical cohort.

RESULTS

In this study, which included 420 incident patients on peritoneal dialysis with a 5-year follow-up, a cumulative incidence of major adverse cardiovascular events (MACE) of 28.8% was found, being higher in the diabetic population at 36.8%. In regard to the nutritional status in this population, it was found that approximately 44% had altered nutritional status; 34% were found to be in sarcopenia; 6.7% sarcopenic obesity; and 2.8% in obesity (p < 0.001). In the survival analysis, a lower probability of survival was found in patients with overhydration (OH) greater than 3 L (p < 0.001) and in patients with altered nutritional status due to sarcopenia, sarcopenic obesity, and obesity (p 0.016). According to survival in the subgroup of the diabetic population, a lower probability of survival was found in this group of patients (p: 0.011). The overall mortality of the study population was 18%, being higher in the first 2 years, with the most important causes of mortality being cardiovascular. Of the deceased population, 51% were diabetic patients (p: 0.012).

CONCLUSION

In incident patients on peritoneal dialysis, sarcopenic obesity, sarcopenia, overhydration status determined by BCM, and having a diagnosis of diabetes are related to a lower probability of survival; MACE outcomes are more frequent in the diabetic population.

Plasma vaspin levels and clinical outcome in incident peritoneal dialysis patients

BACKGROUND

Vaspin is an adipokine that regulates glucose and lipid metabolism. Plasma vaspin level is increased in chronic kidney disease but decreased in hemodialysis patients. However, plasma vaspin level in peritoneal dialysis (PD) patients, as well as its prognostic role, has not been studied.

METHODS

We recruited 146 incident PD patients. Their baseline plasma vaspin levels, body anthropometry, the profile of insulin resistance, bioimpedance spectroscopy parameters, dialysis adequacy, and nutritional indices were measured. They were followed for up to 5 years for survival analysis.

RESULTS

The average age was 58.4 ± 11.8 years; 96 patients (65.8%) were men, and 90 (61.6%) had diabetes. The median vaspin level was 0.18 ng/dL (interquartile range [IQR] 0.11 to 0.30 ng/dL). Plasma vaspin level did not have a significant correlation with adipose tissue mass or baseline insulin level. However, plasma vaspin level had a modest correlation with the change in insulin resistance, as represented by the HOMA-IR index, in non-diabetic patients (r = -0.358, p = 0.048). Although the plasma vaspin level quartile did not have a significant association with patient survival in the entire cohort, it had a significant interaction with diabetic status (p < 0.001). In nondiabetic patients, plasma vaspin level quartile was an independent predictor of patient survival after adjusting for confounding clinical factors (adjusted hazard ratio 2.038, 95% confidence interval 1.191-3.487, p = 0.009), while the result for diabetic patients was not significant.

CONCLUSIONS

Plasma vaspin level quartile had a significant association with patient survival in non-diabetic PD patients. Baseline plasma vaspin level also had a modest inverse correlation with the subsequent change in the severity of insulin resistance, but the exact biological role of vaspin deserves further studies.

Omentin-1 Levels and Outcomes in Incident Peritoneal Dialysis Patients

Rationale & Objective

Omentin-1 is an adipokine with anti-inflammatory and cardioprotective properties. The objective of this study was to determine the prognostic role of plasma omentin-1 levels in incident peritoneal dialysis (PD) patients.

Study Design

Retrospective analysis of prospective cohort.

Setting & Participants

152 incident PD patients.

Predictors

Plasma omentin-1 level, adipose tissue omentin-1 messenger RNA (mRNA) expression.

Outcomes

Patient survival, technique survival, hospital admission, and duration of stay.

Analytical Approach

Time-to-event survival analyses; linear regression for hospitalization.

Results

The mean age was 58.4 ± 11.7 years; 102 were men, and 92 had diabetes. There was no significant correlation between plasma omentin-1 level and its adipose tissue mRNA expression. A higher plasma omentin-1 level quartile was not associated with patient survival (P = 0.92) or technique survival (P = 0.83) but had a modest correlation with a lower number of hospital admissions (P = 0.07) and shorter duration of hospital stay (P = 0.04). In adjusted models using multivariable linear regression, a higher plasma omentin-1 level quartile remained significantly associated with fewer hospital admissions (β, -0.13; 95% CI, -0.26 to -0.002; P = 0.05) and shorter hospitalization duration (β, -0.20; 95% CI, -0.38 to -0.02; P = 0.03).

Limitations

Observational study with baseline measures only.

Conclusions

Plasma omentin-1 level was not associated with patient survival, technique survival, or peritonitis, but higher plasma omentin-1 levels were associated with fewer hospital admissions and shorter duration of hospitalization among incident PD patients.

Obesity, Weight Gain, and Fluid Overload in Peritoneal Dialysis

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.

Higher Serum Total Cholesterol to High-Density Lipoprotein Cholesterol Ratio Is Associated with Increased Mortality among Incident Peritoneal Dialysis Patients

This study evaluated the association of the serum total cholesterol to high-density lipoprotein cholesterol ratio (TC/HDL-C) with mortality in incident peritoneal dialysis (PD) patients. We performed a multi-center, prospective cohort study of 630 incident PD patients from 2008 to 2015 in Korea. Participants were stratified into quintiles according to baseline TC, HDL-C, LDL-C and TC/HDL-C. The association between mortality and each lipid profile was evaluated using multivariate Cox regression analysis. During a median follow-up period of 70.3 ± 25.2 months, 185 deaths were recorded. The highest TC/HDL-C group had the highest body mass index, percentage of diabetes and serum albumin level. Multivariate analysis demonstrated that the highest quintile of TC/HDL-C was associated with increased risk of all-cause mortality (hazard ratio 1.69, 95% confidence interval 1.04-2.76; p = 0.036), whereas TC, HDL-C and LDL-C were not associated with mortality. Linear regression analysis showed a positive correlation between TC/HDL-C and body mass index. Increased serum TC/HDL-C was an independent risk factor for mortality in the subgroup of old age, female, cardiovascular disease and low HDL-C. The single lipid marker of TC or HDL-C was not able to predict mortality in PD patients. However, increased serum TC/HDL-C was independently associated with all-cause mortality in PD patients.

Association analysis of body composition with survival among prevalent peritoneal dialysis patients

PURPOSE

Progressive decline in lean mass and gain of fat mass are common in patients treated with peritoneal dialysis (PD). It is unclear whether body composition or its longitudinal changes contribute to increased mortality among prevalent PD patients.

METHODS

This was a retrospective cohort study. Body composition was assessed using bioelectrical impedance spectroscopy (BIS). Lean and fat tissue indices were derived from lean and fat mass indexed to height-squared, respectively. The patient's baseline BIS results were used to explore its mortality risk prediction for the entire cohort. Among patients with subsequent BIS measurements, changes of lean and fat mass over time were also examined with survival outcomes.

RESULTS

Among all participants (n = 555, PD vintage 38 months), higher baseline lean tissue index was associated with lower mortality after adjusting for fat tissue index and confounders (HR 0.90; 95% CI 0.84-0.97, p = 0.01). However, this association was no longer significance after the final adjustment with serum albumin level (p = 0.06). A total of 136 patients had repeated BIS data. After the interval of 10.1 months during two consecutive BIS measurements, there was a strong inverse correlation between the percentage changes of lean and fat tissue indices (r = - 0.73, p < 0.001). The longitudinal changes in lean mass, either high or low categories, were not significantly associated with all-cause mortality. In contrast, patients who were classified as having low values of fat tissue index (below median) from baseline to the next BIS measurements had a lower odds of death in the univariable (HR 0.32; 95% CI 0.12-0.84, p = 0.02) but not in the adjusted models.

CONCLUSION

Among prevalent PD patients, higher baseline lean mass was independently associated with better survival. However, the longitudinal changes in lean mass were not significantly associated with mortality. In contrast, the maintenance of low fat status over time appeared to be associated with a lower likelihood of death among PD population.

Analysis of Risk Factors Affecting The Occurrence of Chronic Obstructive Pulmonary Disease in Indonesia

Background: Chronic obstructive pulmonary disease (COPD) is a lung disease caused by the occurrence of airflow limitation in the lungs and also causes 60% of all deaths in Indonesia. Purpose: This study aimed to analyze the risk factors that affect the incidence of COPD in Indonesia. Methods: This study was conducted in July–August 2019 in Indonesia as an analytic research study with a cross-sectional design, using data from the Indonesia Family Life Survey-5. The sample consisted of respondents aged >15 years, giving a total of 34,231 respondents. Data analysis was partially carried out using the chi-square test to analyze the relationships between the variables. Results: The majority of respondents were female, were aged <40 years, and had a low level of education. Risk factors for the development of COPD included, among others, an age of >40 years (p = 0.02; PR = 1.20; 95% CI = 1.02–1.41), male gender (p = 0.01; PR = 1.26; 95% CI = 1.07–1.49), smoking (p = 0.01; PR = 1.22 ; 95% CI = 1.03–1.44), first smoking age < 40 years (p = 0.02; PR = 1.22; 95% CI = 1.03–1.44), residence in urban areas (p = 0.01; PR = 1.43; 95% CI = 1.20–1.70), being underweight (p = 0.01; PR = 2.17; 95% CI = 1.76–2.66). Conclusions: The risk factors that affect the incidence of COPD include being aged >40 years, being male, smoking, taking up smoking when aged <40 years, urban residence, and being underweight.

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)

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.

Socioeconomic status and mortality among dialysis patients: a systematic review and meta-analysis

BACKGROUND

The reported association between individual indicators of socioeconomic status (SES) and mortality in dialysis patients was inconsistent in previous studies. We performed a meta-analysis to identify the association between SES and mortality of dialysis population.

METHODS

The meta-analysis was conducted in accordance with MOOSE guidelines. Cohorts evaluating the association between SES indicators (income, education and occupation) and mortality in dialysis patients were included. Random-effects models were used to pool the adjusted relative risk (RR) from individual studies. Heterogeneity was assessed by Cochrane's Q and the I² statistic. Subgroup analyses and sensitivity analyses were performed to identify sources of heterogeneity and to evaluate the robustness of findings.

RESULTS

Fourteen studies were finally included. In hemodialysis patients, increased mortality was associated with lower level of income (RR = 1.08, 95%CI [1.01-1.16], P = 0.035; I² = 87.9%, P < 0.001) and occupation (RR = 1.63, 95%CI [1.11-2.38], P = 0.013; I² = 0.0%, P = 0.601). However, no significant association was identified for education (RR = 1.43, 95%CI [0.92-2.25]; P = 0.112; I² = 68.3%,P = 0.001). In patients receiving peritoneal dialysis, lower level of income (RR = 1.80, 95%CI [1.12-2.88],P = 0.015; I² = 75.9%, P = 0.042), education (RR = 1.27, 95%CI [1.13-1.43], P < 0.001; I² = 0.0%, P = 0.684), and occupation (RR = 3.42, 95% CI [1.35-8.70], P = 0.010) were risk factors for increased mortality. Subgroup analysis showed the association between SES indicators and mortality in hemodialysis differed according to geographic locations and study designs.

CONCLUSION

Lower SES (measured by income, education, and occupation) tends to be associated with higher mortality in patients receiving maintenance dialysis. But the magnitude of the associations varied for different individual indicators of SES.

Clinical value of body composition monitor to evaluate lean and fat tissue mass in peritoneal dialysis

BACKGROUND/OBJECTIVES

Bioimpedance analysis is often routinely performed in any dialysis unit to guide fluid management but can provide a reproduceable assessment of fat and muscle mass. We wished to determine the clinical significance of low muscle or high fat mass and the determinants that influence their change.

SUBJECTS/METHODS

We performed retrospective analysis of 824 patients on peritoneal dialysis who underwent routine repeated bioimpedance analysis measurements using the body composition monitor (BCM).

RESULTS

Lean tissue index (LTI) was an independent predictor of mortality when sex, age, PD vintage and diabetes status were included in the models (HR 0.93; 95% CI 0.86-1.00, p < 0.05) and when baseline serum albumin was included in a separate model (HR 0.86; 95% CI: 0.79-0.93, p < 0.001). High fat tissue index (FTI) was an independent predictor of mortality when demographic factors were included (HR 0.87; 95% CI: 0.78-0.97, p < 0.02), but not with the addition biochemical parameters. Changes in body composition of 206 patients over a 2-year follow-up period could not be predicted by baseline demographics, functional or biochemical assessments. However, there was a strong inverse relationship between changes in LTI and FTI. There were no associations between changes in body composition with prescribed dialysate glucose.

CONCLUSIONS

We showed body composition changes are common and complex. LTI was an independent predictor of survival. Changes in LTI and FTI could not be predicted by baseline parameters. BCM may be a sensitive and accurate tool to monitor changes in body composition during dialysis treatment.

The effects of oral nutritional supplements in patients with maintenance dialysis therapy: A systematic review and meta-analysis of randomized clinical trials

Background/objective

This systematic review aims to determine the potential effects of oral nutritional supplements (ONS) in patients receiving maintenance dialysis therapy (MDT).

Methods

Electronic databases were searched without language limits through to July 2018. Randomized controlled trials (RCTs) that involved comparisons of ONS versus placebo or routine care are included in this meta-analysis. RevMan 5.3 statistical software was used for meta-analysis.

Results

15 articles with 589 subjects were included in our study. There are insufficient comparable data of randomized trials to allow meta-analysis of mortality. Albumin levels may be improved by the macronutrient blends or protein/amino acid supplements in MDT patients. Compared with the control group, serum albumin levels and BMI in the ONS group were increased by 1.58 g/L (95% CI, 0.52–2.63, P = 0.003; I² = 85%) and 0.40 kg/m² (95% CI, 0.10–0.71, P = 0.01; I² = 49%), respectively. In the subgroup analysis of patients receiving hemodialysis, albumin levels in ONS group were increased by 2.17 g/L (95% CI, 0.89–3.45, P<0.001; I² = 90%). ONS may not influence serum phosphorus and potassium levels.

Conclusions

Very low-quality evidence suggests that Short-term oral energy or protein/amino acid supplements may improve nutritional status by increasing serum albumin levels and BMI in MDT patients, without influence on serum potassium levels. High-quality and large RCTs, particularly regarding the effects of ONS on mortality and quality of life, are needed to further validate our findings.