MO698IS PERITONEAL DIALYSIS SUITABLE METHOD FOR OBESE PATIENTS?

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Tatjana Damjanovic ◽  
Jelena Bjedov ◽  
Vesna Maslarevic Radovic ◽  
Bojan Stopić ◽  
Tatjana Rajcic ◽  
...  

Abstract Background and Aims In recent years, obesity has reached epidemic proportions, and it's a great challenge to choose an adequate treatment for obese ESRD patients. The aim of the study was to analyze the outcome in patients with peritoneal dialysis with different degrees of nutrition expressed through body mass index at the beginning of treatment. Method The prospective clinical study included 53 incidental patients, who started peritoneal dialysis between June 2006 and August 2015. According to BMI on the beginning of treatment, patients were divided into three groups: normal weight: BMI of 18.5 - 24.9 kg/m2, n=17, overweight: BMI of 25 - 29.9 kg/m2, n=25, obese: BMI> 30.0 kg/m2. n=11. Mechanical and infective complications, technique survival and patients survival were analyzed over 48 - months period. Results In terms of mechanical complications, there was no difference between the groups- malposition of the catheter (p = 0.769), leakage of dialysate (p = 0.462), hernia (p = 0.381). Exit sitе infection were most prevalent in group 3 - 1 episode/22 patient months vs 1 episode/30 patient months in groups 1 and 2, but without statistical significance (p = 0.272). However, the lowest incidence of peritonitis was in the group 3 - 1 episode/40 patient months vs 1 episode/30 patient months in group 2, and 1 episode/33 patient months in group 1, but even here the difference did not reach statistical significance (p = 0.624). Cardiovascular events – myocardial infarction, stroke and peripheral vascular disease were rare in all groups, with no statistical significance between groups. The incidence of hospitalizations was highest in the obese group – 1 episode/22 patient months vs 1 episode/27 patient months in group 2, and 1 episode/25 patient months in group 1 (p = 0.735). Kaplan Meier's analysis showed the worst, but not significant, survival of the technique in a group of obese patients (group 1 vs. group 2; p = 0.536; group 1 vs. group 3 - p= 0.662; group 2 vs. group 3 - p = 0.357). Also, overall patient survival was not differed between the groups (group 1 vs group 2 - p = 0.387; group 1 vs group 3 - p= 0.885; group 2 vs group 3 - p = 0.375). According to Cox's analysis, only values of total cholesterol at the end of the follow-up period (p = 0.027) and diastolic blood pressure (p = 0.013) were significantly associated with overall survival obese patients. Conclusion In the present study the degree of nutrition at the beginning of treatment had no significant effect on the outcome of peritoneal dialysis treatment. Therefore, patients should not be discouraged for peritoneal dialysis on the basis of BMI.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4935-4935 ◽  
Author(s):  
Martin Hoffmann ◽  
Raoul Bergner ◽  
Marion Stützle ◽  
Michael J. Uppenkamp ◽  
Rabea Foerster

Abstract Abstract 4935 Background Doxorubicin (Dox) is the back bone of chemotherapy in the therapy of several types of carcinomas, lymphomas and acute leukemias. Obese patients (Body Mass Index > 30) have due to their body weight a relatively high Body Surface Area (BSA). Their calculated doxorubicin dose is therefore greater than for patients with normal weight. This could lead to overdosing in case of e.g. a reduced drug clearance. Otherwise a recent study demonstrated a worse outcome in women receiving adjuvant therapy with reduced chemotherapy dose. Patients and methods Eligible were patients above the age of 18 years and receiving the first or second cycle of a Doxorubicin-based chemotherapy. Patients were divided due to their BMI in three groups (group 1: BMI < 25; group 2: BMI ≥ 25 and < 30, group 3: BMI ≥ 30). Dox was administered in a dose of 50 mg/m2 as infusion over 15 minutes. Blood samples were obtained at 0, 0.25, 0.5, 1, 2, 3, 4, 8, 12, 24 hours. Dox and its metabolite Doxorubicinol were measured by High Performance Liquid Chromatography. Area under the curve (AUC), clearance (Cl), half life (T1/2), and volume of distribution in steady state (Vss) were calculated using a 2-compartment-model for Dox and a non-compartmental-model for Doxorubicinol with PK software (WinNonlin). Results 31 Patients with untreated indolent or aggressive lymphomas were included in the study. Patients received CHOP-21 or CHOP-14 + G-CSF. 11 were in group 1, 10 in group 2 and 10 in group 3. 18 patients were male and 13 female. The mean age was 66 ± 10 years. The mean BMI was 27.9 ± 4.9 (group 1: 22.5 ± 2.1 group 2: 28.0 ± 1.4; group 3: 33.9 ± 1.8). Patients received a mean dose of 95.5 mg Dox (87.3 ± 8.1, 99.1 ± 10.2, 100.8 ± 7.5). We found a significant difference between the groups for the AUC by an analysis of variance. (p=0.014). This was also noticed for the differences between group 1 and 3 (p=0.029) and 2 and 3 (0.042) evaluated by a Scheffe test. The Cl showed no statistically significant difference (p=0.079). The BMI correlated (P=0.046) with the AUC. The AUC of Doxorubicinol was significantly different between the three groups (p=0.009), as was the clearance (p=0.04). The BMI was correlated with the AUC (p=0.009), the Cl (p=0.003), and T1/2 (p=0.036). We did not find any correlation between the pharmacokinetic parameters of Dox or Doxorubicinol and response to therapy. The evaluation of the hematological toxicity showed a non significant trend for higher WHO grade 3–4 leucopenia in patients with increased AUC of Dox. Conclusion The AUC in the patient group with BMI ≥ 30 was increased. This was caused by a reduced clearance as there was no relevant difference to the other groups in Vss. This suggested that Dox and Doxorubicinol penetrate only minimally into the fat tissue. However, the pharmacokinetic parameters of Dox and Doxorubicinol in non obese and obese patients showed considerable interindividual variability. The hematologic toxicity in obese patients was not significantly increased and therapy outcome did not correlate with any pharmacokinetic parameter. Thus, based on these data, we can not recommend a reduction of dose for Dox in patients up to a BMI of 35. Disclosures: No relevant conflicts of interest to declare.


2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 700.1-700
Author(s):  
E. Trallero-Araguás ◽  
F. Romero ◽  
I. Castellví ◽  
V. Ortiz-Santamaria ◽  
S. Castañeda ◽  
...  

Background:Idiopathic inflammatory myopathies are a heterogenous group of systemic autoimmune diseases. Several phenotypes have been linked to specific autoantibodies. Clinically amyopathic dermatomyositis with rapidly progressive interstitial lung disease, the most severe form of ILD, is associated with the anti-MDA5 antibodies. However not all the patients with dermatomyositis and anti-MDA5 positive antibodies develop this severe condition.Objectives:We aim to define different phenotypes from a large cohort of patients diagnosed with dermatomyositis who were positive to anti-MDA5 antibodies.Methods:We retrospective analyzed the clinical and immunological data of 90 anti-MDA5 patients [50 female, 55.6%, mean (SD) age at diagnosis 47 (15.4) yrs.] with dermatomyositis recruited from a multicenter register in Spain (MEDRA5) including 30 hospitals. All the patients fulfill de International Myositis Classification Criteria (EULAR/ACR) for dermatomyositis (score >90%). Anti-MDA5 were detected by means of commercial immunoblot (EUROIMMUN©). The chi-square test was used to assess the relationships between qualitative variables. The Kruskal-Wallis test was used to compared medians between groups.Results:Sixty-six patients (73.3%) were diagnosed with clinically amyopathic dermatomyositis. Three different phenotypes linked with the anti-MDA5 antibody were identified. Group 1: patients with rapidly-ILD phenotype (28 patients, 31.1%), group 2: antisynthetase-like phenotype (23 patients, 25.5%), and group 3: non-ILD phenotype (39 patients, 43.3%). Clinical and immunological comparison between the groups disclosed that age at disease onset was higher (median, IQR) in patients from group 1 [53 (43-60)] vs. group 2 [46 (40-56)] or group 3 [42(41-51)] (p=0.01); disease onset was more frequent in spring in patients from group 1 (46.5%) than in the rest of the groups (21.7% and 28.9%) (p<0.01). Cancer was detected in 7 patients, only associated with myositis in 3 cases (3 years interval between cancer and dermatomyositis) without significant differences between phenotypes. Vasculitis (one case ANCA positive) was detected in 9 cases (6 limited to skin, 1 renal and 1 intestinal), 6 of them in the group 3 (statistical significance, in comparison with group 1 and 2, p<0.01). Mortality rate was higher in group 1 (51.9%, 16 out of 17 due to refractory respiratory failure) vs group 2 (12.5%) or 3 (0%) (p<0.001). Anti Ro52 positivity was more frequent in group 1 (65.4%) vs. group 2 (25%) or 3 (35.5%) (p<0.017), although it did not reach statistical significance in terms of mortality (p=0.173) or patients admitted in the intensive care unit (p=0.173). Mechanic hands were more frequent in group 2 (40.6%) than in groups 1 (25%) and 3 (34.4%) (p=0.05). Fever was significantly most frequent in group 1(52.6%) than in group 2 (21.1%) and 3 (26.3%) (p=0.001). Other clinical or immunological features such as arthritis, myositis, or the number of characteristic skin lesions among others were not more frequent in one group or another.Conclusion:Three different phenotypes of patients positive to anti-MDA5 were identified. The presence or not of ILD, or the different type (rapidly progressive or not) of ILD were the main feature that allow to differentiate these phenotypes, which are relevant in clinical practice.References:[1]Allenbach Y, Uzunhan Y, Toquet S, et al; French Myositis Network. Different phenotypes in dermatomyositis associated with anti-MDA5 antibody: Study of 121 cases. Neurology. 2020;95: e70-e78.Acknowledgements:List of contributors of MEDRA5 group: Aguilar-García J (Internal Medicine, Hospital Costa del Sol, Marbella), Carrión-Barberá I (Rheumatology, Hospital del Mar, Barcelona), Cobo-Ibañez T (Rheumatology, Hospital Infanta Sofía, San Sebastián de los Reyes), de Escalante-Yangüela B (Internal Medicine, Hospital Clínico Lozano Blesa, Zaragoza), Fonseca-Aizpuru EM (Internal Medicine, Hospital de Cabueñes, Gijón), González-Cubillo L (Intensive Medicine, Hospital Universitario de Cruces, Barakaldo), González-Gay MA (Rheumatology, Hospital Marqués de Valdecilla, Santander), Prieto-González S (Internal Medicine, Hospital Clinic, Barcelona), Ruiz-Román A (Rheumatology, Hospital Universitario Virgen del Rocío, Sevilla), Calero-Paniagua I (Internal Medicine, Hospital Virgen de la Luz, Cuenca), Callejas-Rubio JL (Internal Medicine, Hospital Clínico San Cecilio, Granada), Gil-Vila A (Internal Medicine, Hospital Vall d’Hebron, Barcelona), de Miguel-Campo B (Internal Medicine, Hospital Doce de Octubre, Madrid), García-Sevilla R (Pneumology, Hospital General Universitario de Alicante, Alicante), Iriarte-Fuster A (Internal Medicine, Hospital de Bellvitge, Hospitalet de Llobregat), Jovani-Casano V (Rheumatology, Hospital General Universitario de Alicante, Alicante), Lozano-Rivas N (Rheumatology, Hospital Virgen de la Arritxaca, Murcia), Martín-Gascón M (Internal Medicine, Hospital Morales Meseguer, Murcia), Martinez-González O (Rheumatology, Hospital Universitario de Salamanca, Salamanca), Monteagudo-Jiménez M (Internal Medicine, Hospital Parc Taulí, Sabadell), Mora-Ortega GM (Pneumology, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes), Moral-Moral Pedro (Internal Medicine, Hospital Universitari i Politecnic La Fe, Valencia), Pérez-De Pedro I (Interna Medicine, Hospital Regional Universitario de Málaga, Málaga), Picazo-Talavera MR (Rheumatology, Hospital del Sureste, Madrid), Rubio-Rivas M (Internal Medicine, Hospital de Bellvitge, Hospitalet de Llobregat)Disclosure of Interests:None declared


2009 ◽  
Vol 29 (2_suppl) ◽  
pp. 78-82 ◽  
Author(s):  
Yanjun Li ◽  
Jie Dong ◽  
Li Zuo

Objective We investigated whether patients with gastrointestinal (GI) symptoms were prone to be diagnosed as malnourished by subjective global assessment (SGA) by simultaneously evaluating SGA and other indices of nutrition in a cross-sectional survey of peritoneal dialysis (PD) patients. Patients and Method From June 2006 to June 2007, 214 PD patients were involved in the study. We recorded results of a GI symptoms questionnaire (GSQ) and SGA. Other indices of nutrition included dietary intake, chemistry examination, anthropometry, handgrip strength, and lean body mass measured by creatinine kinetics. Results Mean age of the 214 PD patients enrolled in the study was 60.22 ± 14.02 years, and mean dialysis duration was 60.22 ± 14.02 months. Of the 214 patients, 56 (27.16%) were diagnosed as malnourished by SGA. The mean GSQ scores were 9.37 ± 1.71 (range: 8 – 17). There were 90 patients with GSQ scores of 8 (group 1), 80 patients with scores of 9 or 10 (group 2), 44 patients with scores of 11 or more (group 3). The prevalence of malnutrition diagnosed by SGA was significantly different in the three groups: 15.56% in group 1, 27.5% in group 2, and 45.45% in group 3 ( p = 0.02). However, we observed no difference between the three groups in mid-arm circumference, skinfold thickness (biceps, triceps, subscapular, and suprailiac), daily protein and energy intake, handgrip strength, lean body mass, and serum albumin and prealbumin levels ( p > 0.05). Conclusions Our results showed that the reliability of SGA in PD patients with GI symptoms remains worth exploring. These patients are possibly diagnosed as malnourished by SGA, although many other indices of nutrition are not necessarily bad.


1997 ◽  
Vol 65 (2) ◽  
pp. 267-273 ◽  
Author(s):  
I. A. Forsyth ◽  
F. E. Gebbie ◽  
J. Arendt

AbstractTo avoid winter scarcity of fresh goat milk, simple methods of advancing the season of kidding would be commercially valuable. A combination of long-day light treatment followed by melatonin is successful but other aspects of seasonality including coat growth are also reset. To investigate whether effects on breeding season and coat growth can be dissociated, British Saanen dairy goats (no. = 30) were randomly allocated to one of six groups. Control goats were untreated. Goats in the other five groups received 2 months of treatment with 20 h light: 4 h darkness (20L: 4D) and were then given 3 mg melatonin orally at 16.00 hfor 2 months. The treatments started on 11 January (group 1), 29 March (group 2), 14 June (group 3), 30 August (group 4) and 8 November (group 5). Weekly blood samples were taken for the measurement of progesterone to monitor ovarian activity and prolactin. Side patches (10 cm ×10 cm) were clipped monthly from alternate sides and weighed to measure coat growth. The onset of ovarian activity was advanced from a median date of 15 November in controls to 24 May in group 1 (P < 0·01), 16 August in group 2 (P < 0·05) and 18 October in group 3 (? < 0·05). Groups 4 and 5 showed no significant change in the onset of oestrus (median onset dates 8 November and 1 November, respectively). Group 1 goats came into season again with controls in November. In all except group 5, treatment interacted with time to affect significantly the growth of the coat. The pattern of coat growth was most altered (P < 0·001) in groups 1 and 2. This was associated with effects on plasma prolactin concentrations of light stimulation and melatonin suppression. Group 1 goats resynchronized with control goats to show a coat of normal weight in the winter following treatment. Division of milking goat herds into spring and autumn kidding groups is, therefore, a practical possibility, but effects on overall milk yield require study.


Author(s):  
Hyunsoo Kim ◽  
Kijeong Kim ◽  
Sohee Shin

The aim of this study was to investigate the cardiometabolic risk factors (CRFs) in community dwelling men based on a combination of body mass index (BMI) and waist circumference (WC). This cross-sectional study was based on 867 males between the ages of 20 and 71 years. Subjects were categorized into 4 groups by BMI and WC (Group 1, BMI < 25 kg/m2 and WC < 90 cm; Group 2, BMI < 25 kg/m2 and WC > 90 cm; Group 3, BMI > 25 kg/m2 and WC < 90 cm; and Group 4 BMI > 25 kg/m2 and WC > 90 cm). The proportion of subjects with a normal weight with high WC was 3.2%. Among normal weight men with the high range of WC, significantly high Odds ratios (ORs) and 95% CI were found for hypertriglyceridemia (3.8, 1.8–8.2) and high blood glucose (3.2, 1.5–6.9). The probability that the general obesity group (Group 3) had one CRF was around twice that of the reference group (Group 1) (1.9 to 2.1 times), but Group 2 had probability more than 4 times higher (4.3 to 4.6 times). In community dwelling adult men, normal weight with high waist circumference was associated with the highest cardiometabolic risk. In conclusion, follow-up screening of those with high WC may be necessary to detect and prevent cardiometabolic diseases, particularly for men with a normal weight.


2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Weiss ◽  
R De Caterina ◽  
P Kelly ◽  
P Monteiro ◽  
J C Deharo ◽  
...  

Abstract Background Non-vitamin K antagonist (VKA) oral anticoagulants (NOACs) have substantially improved anticoagulation therapy for prevention of stroke and systemic embolism in patients with atrial fibrillation (AF), and available routine care data have so far broadly confirmed the safety of different NOACs in routine practice. However, such data for edoxaban are scarce, especially in extremely low and high body weight (BW). These extreme BWs may affect the bioavailability, distribution, and half-life of NOACs and, consequently, outcomes of treatment. Methods We analysed outcomes in normal-weight (BMI 18.5–25) vs overweight (BMI 25–30) and obese (BMI >30) patients enrolled into the ETNA-AF-Europe observational study (NCT02944019) collecting information on patients treated with edoxaban in 825 sites in 10 European countries. This snapshot analysis set includes data of 7,672 patients (56.3% of all enrolled patients) which have completed their 1-year follow-up visit (mean follow-up: 343.5 days). Results Median patient age was 74 years for all patients, 76 years for patients with a BMI 18.5–25 (group 1), 75 years for patients with BMI 25–30 (group 2), and 72 for patients with a BMI >30 (group 3). CrCl was 64 mL/min for patients with a BMI 18.5–25, 68 mL/min for patients with BMI 25–30, and 72 mL/min for patients with a BMI >30. The CHA2DS2-VASc (mean 3.1±1.38) and HAS-BLED (mean 2.5±1.10) score did not differ significantly between groups. As expected, diabetes and hypertension were significantly less prevalent in leaner patients and - accordingly - inversely correlated to age. There was no correlation between body weight and life-threatening bleeding (group 1: 0.28%; group 2: 0.40%; group 3: 0.14%). Also, stroke rates (group 1: 0.74%; group 2: 0.81%; group 3: 0.76%) did not differ between groups. Conclusion BMI, within the range here assessed, does not affect 1-year outcomes in European AF patients treated with edoxaban. Acknowledgement/Funding Daiichi Sankyo Europe GmbH, Munich, Germany


2012 ◽  
Vol 30 (27) ◽  
pp. 3389-3395 ◽  
Author(s):  
Joseph A. Roscoe ◽  
Charles E. Heckler ◽  
Gary R. Morrow ◽  
Supriya G. Mohile ◽  
Shaker R. Dakhil ◽  
...  

Purpose We conducted a double-blind randomized clinical trial of the following four regimens for controlling delayed nausea (DN): group 1: palonosetron + dexamethasone on day 1 with prochlorperazine on days 2 and 3; group 2: granisetron + dexamethasone on day 1 with prochlorperazine on days 2 and 3; group 3: aprepitant + palonosetron + dexamethasone on day 1 with aprepitant + dexamethasone on days 2 and 3; and group 4: palonosetron + dexamethasone on day 1 with prochlorperazine + dexamethasone on days 2 and 3. Patients and Methods Chemotherapy-naive patients received doxorubicin, epirubicin, cisplatin, carboplatin, or oxaliplatin. The primary end point was average nausea assessed four times daily on days 2 and 3. Primary analyses were whether nausea control would be improved by using palonosetron versus granisetron on day 1 (group 1 v group 2); by adding dexamethasone on days 2 and 3 (group 1 v group 4); and by using aprepitant versus prochlorperazine (group 3 v group 4). Statistical significance was set at P = .017. Results Two hundred thirty-four, 234, 241, and 235 evaluable patients were accrued to groups 1, 2, 3, and 4, respectively. Adjusted mean differences for the three planned analyses were as follows: palonosetron versus granisetron: −0.01 (95% CI, −0.23 to 0.20; P = .72); adding dexamethasone on days 2 and 3: 0.20 (95% CI, −0.02 to 0.41; P = .01); and using aprepitant versus prochlorperazine: −0.03 (95% CI, −0.24 to 0.19; P = .56). Conclusion The addition of dexamethasone on days 2 and 3 reduced DN. Palonosetron and granisetron have similar effects on DN. The beneficial effect of adding aprepitant for control of DN was the same as adding prochlorperazine.


2006 ◽  
Vol 14 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Mara Cristina Santos Felippe ◽  
Wilson Tadeu Felippe ◽  
Catherine Schmitz Espezim ◽  
Sérgio Fernando Torres de Freitas

AIM: To evaluate the effect of different irrigant solutions employed during removal and replacement of calcium hydroxide paste on the diffusion of hydroxyl ions through root canal dentine in vitro. METHODOLOGY: Thirty-five maxillary and mandibular human canines with straight and fully developed roots were used. After mechanical preparation up to 1mm short of tooth length, 30 canals were filled with calcium hydroxide paste and 5 canals were left empty; all teeth had their coronal accesses properly sealed. Teeth were placed in plastic containers with distilled water, and pH was read after 30 days when the paste from 20 teeth was renewed. After removal of the paste by endodontic instrumentation and irrigation with distilled water, canals were replenished with newly mixed paste in Group 1 and 2. In these groups, final irrigation was conducted with 5 mL of EDTA followed by 5 mL of NaOCl in specimens in Group 1, and 5 mL of NaOCl only in specimens in Group 2. In 10 teeth the paste was not replenished at 30 days (Group 3). All specimens were returned to the containers with fresh distilled water, and the pH was recorded after another 30 days. The differences between the first (30d) and second (60d) pH readings were calculated and submitted to analysis of variance and individual comparisons using the Scheffeé's test. RESULTS: Results of mean analysis on differences of pH readings showed that greater diffusion had occurred on specimens in Group 3. Individual comparisons using Scheffeé's test showed statistical significance between Groups 2 and 3, and equivalence between all other groups. CONCLUSION: It was concluded that the use of EDTA did not enhance diffusion of hydroxyl ions through root canal dentine.


2013 ◽  
Vol 59 (3) ◽  
pp. 8-12
Author(s):  
L V Kvitkova ◽  
D A Borodkina ◽  
O V Gruzdeva ◽  
O L Barbarash ◽  
A A Silonova ◽  
...  

The present study involed the patients (n=100) presenting with myocardial infarction (MI). Based on the body mass index, they were allocated to three groups: those with normal body mass index (BMI) (18.5≤BMI< 25 kg/m2; n=32; group 1), overweight patients (25≤BMI <30 kg/m2; n=42; group 2), and obese patients (BMI≤30 kg/m2; n=27; group 3). The laboratory studies included the measurement of serum adipocytokine levels (leptin, adiponectin, and free fatty acids (FFA)) in conjunction with the evaluation of insulin resistance (IR). All the patients regardless of BMI had the waist circumference in excess of the upper limit of the normal gender-specific values. Deviations from the reference values of leptin, adiponectin, and FFA levels were observed in 65.6% of the patients with normal BWI, in 69.0% of the overweight patients, and in 70.3% of the obese patients. In the patients of all the three groups, significant correlation was documented between waist circumference and the levels of leptin (group 1: r=0.3100, p=0.00; group 2: r=0.32, p=0.00; group 3: r=0.37, p=0.03) and adiponectin (group 1: r=-0.43, p=0.00; group 2: r=-0.35, p=0.04; group 3: r=-0.18, p=0.01). Moreover, the waist circumference significantly correlated with the occurrence of IR (group 1: r=0.11, p=0.04; group 2: r=0.45, p=0.00, group 3: r=0.34, p=0.03). It is concluded that the observed deviations of the parameters of interest from the respective reference values suggest disturbances in the metabolic and secretory functions of the visceral adipose tissue associated with the enlargement of its volume).


2014 ◽  
Vol 34 (4) ◽  
pp. 399-408 ◽  
Author(s):  
Narayan Prasad ◽  
Archana Sinha ◽  
Amit Gupta ◽  
Raj Kumar Sharma ◽  
Dharmendra Bhadauria ◽  
...  

ObjectivesWe studied the effect of body mass index (BMI) at peritoneal dialysis (PD) initiation on patient and technique survival and on peritonitis during follow-up.MethodsWe followed 328 incident patients on PD (176 with diabetes; 242 men; mean age: 52.6 ± 12.6 years; mean BMI: 21.9 ± 3.8 kg/m2) for 20.0 ± 14.3 months. Patients were categorized into four BMI groups: obese, ≥25 kg/m2; overweight, 23 – 24.9 kg/m2; normal, 18.5 – 22.9 kg/m2(reference category); and underweight, <18.5 kg/m2. The outcomes of interest were compared between the groups.ResultsOf the 328 patients, 47 (14.3%) were underweight, 171 (52.1%) were normal weight, 53 (16.2%) were overweight, and 57 (17.4%) were obese at commencement of PD therapy. The crude hazard ratio (HR) for mortality ( p = 0.004) and the HR adjusted for age, subjective global assessment, comorbidities, albumin, diabetes, and residual glomerular filtration rate ( p = 0.02) were both significantly greater in the underweight group than in the normal-weight group. In comparison with the reference category, the HR for mortality was significantly greater for underweight PD patients with diabetes [2.7; 95% confidence interval (CI): 1.5 to 5.0; p = 0.002], but similar for all BMI categories of nondiabetic PD patients. Median patient survival was statistically inferior in underweight patients than in patients having a normal BMI. Median patient survival in underweight, normal, overweight, and obese patients was, respectively, 26 patient–months (95% CI: 20.9 to 31.0 patient–months), 50 patient–months (95% CI: 33.6 to 66.4 patient–months), 57.7 patient–months (95% CI: 33.2 to 82.2 patient–months), and 49 patient–months (95% CI: 18.4 to 79.6 patient–months; p = 0.015). Death-censored technique survival was statistically similar in all BMI categories. In comparison with the reference category, the odds ratio for peritonitis occurrence was 1.8 (95% CI: 0.9 to 3.4; p = 0.086) for underweight patients; 1.7 (95% CI: 0.9 to 3.2; p = 0.091) for overweight patients; and 3.4 (95% CI: 1.8 to 6.4; p < 0.001) for obese patients.ConclusionsIn our PD patients, mean BMI was within the normal range. The HR for mortality was significantly greater for underweight diabetic PD patients than for patients in the reference category. Death-censored technique survival was similar in all BMI categories. Obese patients had a greater risk of peritonitis.


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