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Nitta K, Bieber B, Karaboyas A, Johnson DW, Kanjanabuch T, Kim YL, Lambie M, Hartman J, Shen JI, Naljayan M, Pecoits-Filho R, Robinson BM, Pisoni RL, Perl J, Kawanishi H. International variations in serum PTH and calcium levels and their mortality associations in peritoneal dialysis patients: Results from PDOPPS. Perit Dial Int 2024:8968608241235516. [PMID: 38501163 DOI: 10.1177/08968608241235516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Mineral bone disorder (MBD) in chronic kidney disease (CKD) is associated with high symptom burden, fractures, vascular calcification, cardiovascular disease and increased morbidity and mortality. CKD-MBD studies have been limited in peritoneal dialysis (PD) patients. Here, we describe calcium and parathyroid hormone (PTH) control, related treatments and mortality associations in PD patients. METHODS We used data from eight countries (Australia and New Zealand (A/NZ), Canada, Japan, Thailand, South Korea, United Kingdom, United States (US)) participating in the prospective cohort Peritoneal Dialysis Outcomes and Practice Patterns Study (2014-2022) among patients receiving PD for >3 months. We analysed the association of baseline PTH and albumin-adjusted calcium (calciumAlb) with all-cause mortality using Cox regression, adjusted for potential confounders, including serum phosphorus and alkaline phosphatase. RESULTS Mean age ranged from 54.6 years in South Korea to 63.5 years in Japan. PTH and serum calciumAlb were measured at baseline in 12,642 and 14,244 patients, respectively. Median PTH ranged from 161 (Japan) to 363 pg/mL (US); mean calciumAlb ranged from 9.1 (South Korea, US) to 9.8 mg/dL (A/NZ). The PTH/mortality relationship was U-shaped, with the lowest risk at PTH 300-599 pg/mL. Mortality was nearly 20% higher at serum calciumAlb 9.6+ mg/dL versus 8.4-<9.6 mg/dL. MBD therapy prescriptions varied substantially across countries. CONCLUSIONS A large proportion of PD patients in this multi-national study have calcium and/or PTH levels in ranges associated with substantially higher mortality. These observations point to the need to substantially improve MBD management in PD to optimise patient outcomes. LAY SUMMARY Chronic kidney disease-mineral bone disorder (MBD) is a systemic condition, common in dialysis patients, that results in abnormalities in parathyroid hormone (PTH), calcium, phosphorus and vitamin D metabolism. A large proportion of peritoneal dialysis (PD) patients in this current multi-national study had calcium and/or PTH levels in ranges associated with substantially higher risks of death. Our observational study design limits our ability to determine whether these abnormal calcium and PTH levels cause more death due to possible confounding that was not accounted for in our analysis. However, our findings, along with other recent work showing 48-75% higher risk of death for the one-third of PD patients having high phosphorus levels (>5.5 mg/dL), should raise strong concerns for a greater focus on improving MBD management in PD patients.
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Affiliation(s)
- Kosaku Nitta
- Department of Nephrology, Tokyo Women's Medical University, Shinjuku, Japan
| | - Brian Bieber
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | | | - David W Johnson
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Department of Kidney and Transplant Services, Princess Alexandra, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
| | - Talerngsak Kanjanabuch
- Division of Nephrology, Department of Medicine and Center of Excellence in Kidney Metabolic Disorders and Dialysis Policy & Practice Program (DiP3), School of Global Health, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yong-Lim Kim
- School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Mark Lambie
- Medicine and Health Sciences, Keele University, Keele, UK
| | | | - Jenny I Shen
- The Lundquist Institute at Harbor-University of California, Los Angeles Medical Center, Torrance, CA, USA
| | | | | | - Bruce M Robinson
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - 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, University of Toronto, Toronto, ON, Canada
| | - Hideki Kawanishi
- Akane Foundation, Tsuchiya General Hospital, Nakaku, Hiroshima, Japan
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Naljayan M, Hunt A, McKeon K, Marlowe G, Schreiber MJ, Brunelli SM, Tentori F. Use of incremental peritoneal dialysis: impact on clinical outcomes and quality of life measure. J Nephrol 2023; 36:1897-1905. [PMID: 37644364 DOI: 10.1007/s40620-023-01703-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 06/09/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Incremental peritoneal dialysis (PD) can be defined as a PD prescription that is less than the standard, full dose prescription and is typically used for patients initiating PD with residual kidney function. It has been suggested that use of incremental peritoneal dialysis may help preserve residual kidney function and may offer better quality of life due to the lower treatment burden, however published evidence is limited. In this study we assessed the associations between incremental peritoneal dialysis use and both clinical outcomes and quality of life measures in a large cohort of incident peritoneal dialysis patients in the US. METHODS We considered adult patients initiating peritoneal dialysis between 31 July, 2015 and 31 May, 2019 within a single dialysis organization. Patients with body weight < 40 kg, amputation, or an estimated glomerular filtration rate > 20 mL/min during the first 4 weeks on peritoneal dialysis were excluded. Patients were assigned to exposure groups based on peritoneal dialysis prescription during dialysis weeks 5-8. Incremental peritoneal dialysis was defined by treatment frequency, number of exchanges/day, and exchange volume (for continuous ambulatory peritoneal dialysis patients) or by treatment frequency and presence/absence of last fill (for automated peritoneal dialysis patients). Analyses were performed separately for continuous ambulatory peritoneal dialysis and automated peritoneal dialysis. For each analysis, incremental peritoneal dialysis patients were propensity score matched to eligible full-dose peritoneal dialysis patients. Patients were followed for a maximum of 12 months until censoring for loss to follow-up or study end. Outcomes were compared using Poisson models (mortality, hospitalization, peritoneal dialysis discontinuation), linear mixed models (estimated glomerular filtration rate), and paired t tests (KDQOL domain scores). RESULTS Among continuous ambulatory peritoneal dialysis patients, compared to full-dose peritoneal dialysis, incremental peritoneal dialysis use was associated with better KDQOL scores on 3 domains: physical composite score (42.5 vs 37.7, p = 0.03), burden of kidney disease (60.2 vs 45.6, p = 0.003), effects of kidney disease (79.4 vs 72.3, p = 0.05). Hospitalization and mortality rates were numerically lower (0.77 vs 1.12 admits/pt-year, p = 0.09 and 5.0 vs 10.2 deaths/100 pt-years, p = 0.22), while no associations were found with estimated glomerular filtration rate or peritoneal dialysis discontinuation rate. Use of incremental peritoneal dialysis was not associated with any discernable effects on outcomes in automated peritoneal dialysis patients. CONCLUSION These results suggest that there may be benefits of using incremental PD in the context of continuous ambulatory peritoneal dialysis, particularly with respect to quality of life as a prescription strategy when initiating peritoneal dialysis. While no significant benefits of incremental peritoneal dialysis were detected among patients initiating automated peritoneal dialysis, no detrimental effects of using incremental schedules were observed for either peritoneal dialysis type.
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Affiliation(s)
- Mihran Naljayan
- DaVita Inc., Denver, CO, USA
- Louisiana State University School of Medicine, New Orleans, LA, USA
| | - Abigail Hunt
- DaVita Clinical Research, Minneapolis, MN, USA
- DaVita Patient Safety Organization, Denver, CO, USA
| | - Katherine McKeon
- DaVita Clinical Research, Minneapolis, MN, USA
- DaVita Patient Safety Organization, Denver, CO, USA
| | - Gilbert Marlowe
- DaVita Clinical Research, Minneapolis, MN, USA
- DaVita Patient Safety Organization, Denver, CO, USA
| | - Martin J Schreiber
- DaVita Clinical Research, Minneapolis, MN, USA
- DaVita Patient Safety Organization, Denver, CO, USA
| | - Steven M Brunelli
- DaVita Clinical Research, Minneapolis, MN, USA
- DaVita Patient Safety Organization, Denver, CO, USA
| | - Francesca Tentori
- DaVita Clinical Research, Minneapolis, MN, USA.
- DaVita Patient Safety Organization, Denver, CO, USA.
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Abstract
PURPOSE OF REVIEW To highlight the epidemiology and pathophysiology of hypertension and obesity in COVID-19 infection RECENT FINDINGS: Hypertension and obesity have emerged as significant risk factors for contracting the COVID-19 virus and the subsequent severity of illness. ACE2 receptor expression and dysregulation of the RAAS pathway play important roles in the pathophysiology of these associations, as do the pro-inflammatory state and cytokine dysregulation seen in obesity. Some of these patterns have also been seen historically in other viral illnesses. Understanding the mechanisms behind the associations between COVID-19, hypertension, and obesity is important in developing effective targeted therapies and monitoring vaccine response and efficacy. More research is needed to apply our growing knowledge of the pathophysiology of COVID-19, hypertension, and obesity to prevention and treatment. Interventions focusing on lifestyle modification in managing hypertension and obesity can potentially have a positive impact on containing this pandemic and future viral illness outbreaks.
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Affiliation(s)
- Annalisa Perez
- Department of Internal Medicine, Section of Nephrology and Hypertension, Louisiana State University, 1542 Tulane Avenue Suite 330, New Orleans, LA, 70112, USA.
| | - Mihran Naljayan
- Department of Internal Medicine, Section of Nephrology and Hypertension, Louisiana State University, 1542 Tulane Avenue Suite 330, New Orleans, LA, 70112, USA
| | - Imran Shuja
- Department of Internal Medicine, Section of Nephrology and Hypertension, Louisiana State University, 1542 Tulane Avenue Suite 330, New Orleans, LA, 70112, USA
| | - Andre Florea
- Department of Internal Medicine, Section of Nephrology and Hypertension, Louisiana State University, 1542 Tulane Avenue Suite 330, New Orleans, LA, 70112, USA
| | - Efrain Reisin
- Department of Internal Medicine, Section of Nephrology and Hypertension, Louisiana State University, 1542 Tulane Avenue Suite 330, New Orleans, LA, 70112, USA
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Naljayan M, Yazdi F, Struthers S, Sharshir M, Williamson A, Simon EE. COVID-19 in New Orleans: A Nephrology Clinical and Education Perspective and Lessons Learned. Kidney Med 2021; 3:99-104. [PMID: 33283183 PMCID: PMC7708233 DOI: 10.1016/j.xkme.2020.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
New Orleans' first case of coronavirus disease 2019 (COVID-19) was reported on March 9, 2020, with a subsequent rapid increase in the number of cases throughout the state of Louisiana. Traditional educational efforts were no longer viable with social distancing and stay-at-home orders; therefore, virtual didactics were integrated into our curriculum. Due to an exponential increase in the number of patients with acute kidney injury requiring kidney replacement therapy, the nephrology sections at Louisiana State University School of Medicine and Tulane University School of Medicine adapted their clinical workflows to accommodate these increased clinical volumes by using prolonged intermittent kidney replacement therapies and acute peritoneal dialysis, as well as other strategies to mitigate nursing burnout and decrease scarce resource use. Telehealth was implemented in outpatient clinics and dialysis units to protect vulnerable patients with kidney disease while maintaining access to care. Lessons learned from this pandemic and subsequent response may be used for future responses in similar situations.
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Affiliation(s)
- Mihran Naljayan
- Section of Nephrology and Hypertension, LSU School of Medicine, New Orleans, LA
| | - Farshid Yazdi
- Section of Nephrology and Hypertension, LSU School of Medicine, New Orleans, LA
| | - Sarah Struthers
- Section of Nephrology and Hypertension, LSU School of Medicine, New Orleans, LA
| | - Moh’d Sharshir
- Section of Nephrology and Hypertension, Tulane School of Medicine and Southeast Louisiana Veterans Healthcare System, New Orleans, LA
| | | | - Eric E. Simon
- Section of Nephrology and Hypertension, Tulane School of Medicine and Southeast Louisiana Veterans Healthcare System, New Orleans, LA
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Nguyen AH, Naljayan M, Yazdi F, Reisin E. Laparoscopic Sleeve Gastrectomy in a Patient on Peritoneal Dialysis. Kidney Int Rep 2020; 5:2361-2364. [PMID: 33305132 PMCID: PMC7710827 DOI: 10.1016/j.ekir.2020.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/06/2020] [Accepted: 09/08/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Anthony Hoan Nguyen
- Department of Medicine, Section of Nephrology and Hypertension, Louisiana State University Health New Orleans, New Orleans, Louisiana, USA
| | - Mihran Naljayan
- Department of Medicine, Section of Nephrology and Hypertension, Louisiana State University Health New Orleans, New Orleans, Louisiana, USA
| | - Farshid Yazdi
- Department of Medicine, Section of Nephrology and Hypertension, Louisiana State University Health New Orleans, New Orleans, Louisiana, USA
| | - Efrain Reisin
- Department of Medicine, Section of Nephrology and Hypertension, Louisiana State University Health New Orleans, New Orleans, Louisiana, USA
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Torres H, Naljayan M, Frontini M, Aguilar E, Barry S, Reisin E. Evaluating Factors Contributing to Dropout in a Large Peritoneal Dialysis Program. Am J Med Sci 2020; 361:30-35. [PMID: 32732078 DOI: 10.1016/j.amjms.2020.06.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/30/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The low prevalence of peritoneal dialysis (PD) (9%) vs. hemodialysis (HD) (88.2%) is partly due to patient dropout from therapy. METHODS This retrospective study identified patients who withdrew from PD between 2016 and 2018 in our program. We evaluated all other factors as controllable losses. Analysis included time on therapy at dropout (very early, early or late) and method of initiation (HD to PD conversion, unplanned PD, or planned start). RESULTS Eighty-three patients enrolled into our PD program. 27 dropped out; 24 were due to controllable factors, 3 due to death, with a median age at dropout of 52 years old. We determined psychosocial factors (PF) to be the largest controllable factor influencing dropout; contributing a 63% rate among all controllable factors. When considering time until dropout, 100% of very early dropout patients and 50% of late dropout patients did so due to PF. Among early dropout patients 67% dropped out due to other medical reasons. The mean time to dropout for PF, other, and infection (INF) were 13, 26, and 33 months, respectively. When considering type of initiation, we found PF to be the largest attributable factor with 50% of unplanned, 100% of planned, and 50% of conversions stopping therapy. CONCLUSIONS Our study indicates that the primary reason for controllable loss from therapy was secondary to PF regardless of the time on therapy or the method of initiation to therapy.
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Affiliation(s)
- Hayden Torres
- Louisiana State University Health Sciences Center in New Orleans - Section of Nephrology and Hypertension, School of Medicine, New Orleans, Louisiana
| | - Mihran Naljayan
- Louisiana State University Health Sciences Center in New Orleans - Section of Nephrology and Hypertension, School of Medicine, New Orleans, Louisiana
| | - Maria Frontini
- Louisiana State University Health Sciences Center in New Orleans - Section of Infectious Diseases, School of Medicine, New Orleans, Louisiana
| | - Erwin Aguilar
- Louisiana State University Health Sciences Center in New Orleans - Section of Nephrology and Hypertension, School of Medicine, New Orleans, Louisiana
| | - Sean Barry
- Louisiana State University Health Sciences Center in New Orleans - Section of Nephrology and Hypertension, School of Medicine, New Orleans, Louisiana
| | - Efrain Reisin
- Louisiana State University Health Sciences Center in New Orleans - Section of Nephrology and Hypertension, School of Medicine, New Orleans, Louisiana.
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Srivatana V, Aggarwal V, Finkelstein FO, Naljayan M, Crabtree JH, Perl J. Peritoneal Dialysis for Acute Kidney Injury Treatment in the United States: Brought to You by the COVID-19 Pandemic. ACTA ACUST UNITED AC 2020; 1:410-415. [DOI: 10.34067/kid.0002152020] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Poyan Mehr A, Sadeghi-Najafabadi M, Chau K, Messmer J, Pai R, Roy N, Friedman D, Pollak MR, Schlondorff J, Naljayan M, Singh T, Lecker SH, Rodby R, Germain M, Rennke H, Stillman IE. The Glomerular Disease Study and Trial Consortium: A Grassroots Initiative to Foster Collaboration and Innovation. Kidney Int Rep 2018; 4:20-29. [PMID: 30596165 PMCID: PMC6308822 DOI: 10.1016/j.ekir.2018.09.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 08/27/2018] [Accepted: 09/17/2018] [Indexed: 01/11/2023] Open
Abstract
Glomerular kidney disorders account for a significant proportion of chronic kidney disease and end-stage renal disease worldwide. Nevertheless, major obstacles make breakthrough progress in diagnosis and cure an ongoing challenge. Here we report the creation of a "grassroots" initiative that aims to provide new opportunities for nephrologists, pathologists, basic and clinical scientists, patients, and industry partners to collaborate in the field of glomerular kidney disease. Members of the medical community, including trainees, nephrologists, and nephropathologists, can participate in the open-access, Web-based, multidisciplinary clinical video case conferences, which provide "peer-to-peer" exchange of clinical and pathological expertise combined with a formal didactic curriculum. Participants can also join other aspects of the broader initiative. These include the participation in a multisite research study to facilitate enrollment of patients into a longitudinal clinical data and biorepository for glomerular kidney disorders. Items included in this prospective registry include the following: an ontology-based patient medical history, which is regularly updated; interval collection and storage of blood and urine samples; DNA collection; and a contact registry for patients who wish to participate in clinical trials. Participating sites and external scientists can leverage access to the database to pursue genetic, biomarker, epidemiological, and observational clinical effectiveness studies. Patients can independently sign up for a supplementary contact registry to participate in clinical trials if eligible. The broad spectrum of activities within this initiative will foster closer collaboration among trainees, practicing nephrologists, pathologists, and researchers, and may help to overcome some of the barriers to progress in the field of glomerular kidney disease.
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Affiliation(s)
- Ali Poyan Mehr
- Division of Nephrology and Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Maryam Sadeghi-Najafabadi
- Division of Nephrology and Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Kristi Chau
- Division of Nephrology and Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph Messmer
- Division of Nephrology and Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Rima Pai
- Division of Nephrology and Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Neil Roy
- Division of Nephrology and Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - David Friedman
- Division of Nephrology and Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Martin R Pollak
- Division of Nephrology and Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Johannes Schlondorff
- Division of Nephrology and Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Mihran Naljayan
- Section of Nephrology and Hypertension and Department of Medicine, The Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Tripti Singh
- Division of Nephrology and Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Stewart H Lecker
- Division of Nephrology and Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Roger Rodby
- Department of Internal Medicine, Division of Nephrology, Rush Medical College, Illinois, USA
| | - Michael Germain
- Baystate Medical Center, University of Massachusetts Medical School, Springfield, Massachusetts, USA
| | - Helmut Rennke
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Isaac E Stillman
- Division of Nephrology and Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.,Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
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Vareldzis R, Naljayan M, Reisin E. The Incidence and Pathophysiology of the Obesity Paradox: Should Peritoneal Dialysis and Kidney Transplant Be Offered to Patients with Obesity and End-Stage Renal Disease? Curr Hypertens Rep 2018; 20:84. [PMID: 30051236 DOI: 10.1007/s11906-018-0882-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW To educate nephrologists and primary-care physicians about the incidence, pathophysiology, and survival benefits of the obesity paradox in end-stage renal disease (ESRD). This review also discusses the future of kidney transplant and peritoneal dialysis in obese dialysis patients. RECENT FINDINGS Obesity paradox in ESRD was first reported three decades ago, and since then, there have been several epidemiological studies that confirmed the phenomenon. Regardless of the anthropometric indices used to define obesity in ESRD patients, these markers serve to predict the dialysis patient's survival. The pathophysiology of obesity paradox tends to be multifactorial. Recent cohort studies demonstrated a survival benefit in all race and ethnic groups, but Hispanics and blacks experienced increased survival rates when compared to non-Hispanic whites. Obese dialysis patients should be offered peritoneal dialysis, especially if they are new to dialysis and have an adequate renal residual function. Several studies have shown that the benefit of receiving kidney transplant in obese patients exceeds the risks. The robotic-assisted kidney transplant (RAKT) procedure is the latest innovation that could offer hope for obese dialysis patients who have been denied or are waiting for kidney transplant. The obesity paradox phenomenon in ESRD is a unique illustration of survival benefit in a population that has a high overall annual mortality. Peritoneal dialysis should be encouraged for obese patients who have preserved residual renal function. Kidney transplant centers should encourage RAKT utilization in obese dialysis patients instead of denying them a kidney transplant.
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Affiliation(s)
- Ramzi Vareldzis
- School of Medicine, Department of Medicine, Section of Nephrology and Hypertension, Louisiana State University Health Sciences Center-New Orleans, LSUHSC: 1542 Tulane Ave, New Orleans, LA, 70112, USA.
| | - Mihran Naljayan
- School of Medicine, Department of Medicine, Section of Nephrology and Hypertension, Louisiana State University Health Sciences Center-New Orleans, LSUHSC: 1542 Tulane Ave, New Orleans, LA, 70112, USA.
| | - Efrain Reisin
- School of Medicine, Department of Medicine, Section of Nephrology and Hypertension, Louisiana State University Health Sciences Center-New Orleans, LSUHSC: 1542 Tulane Ave, New Orleans, LA, 70112, USA.
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Coulon A, Kamat R, Jaikishen A, Naljayan M. Actinomyces Peritonitis: A Unique Therapy. Am J Med Sci 2017; 354:521-522. [DOI: 10.1016/j.amjms.2017.03.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 03/12/2017] [Accepted: 03/15/2017] [Indexed: 11/30/2022]
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Naljayan M, Kumar S, Steinman T, Reisin E. Hypomagnesemia and hypokalemia: a successful oral therapeutic approach after 16 years of potassium and magnesium intravenous replacement therapy. Clin Kidney J 2014; 7:214-6. [PMID: 25852875 PMCID: PMC4377789 DOI: 10.1093/ckj/sfu014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 02/11/2014] [Indexed: 11/25/2022] Open
Affiliation(s)
- Mihran Naljayan
- Division of Nephrology and Hypertension, Department of Medicine , Louisiana State University Health Sciences Center , New Orleans, LA , USA
| | - Suresh Kumar
- Division of Nephrology and Hypertension , Louisiana State University Health Sciences Center , New Orleans, LA , USA
| | - Theodore Steinman
- Harvard Medical School , Beth Israel Deaconess Medical Center , Boston, MA , USA
| | - Efrain Reisin
- Division of Nephrology and Hypertension , Louisiana State University Health Sciences Center , New Orleans, LA , USA
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