The Relationship Between Abdominal Obesity And Mortality In Continuous Ambulatory Peritoneal Dialysis Patients

Background:In the general population, obesity is one of the most established risk factors for cardiovascular disease (CVD) and increased mortality. Furthermore, it has been known that the fat distribution has different metabolic effect and abdominal fat is more closely associated with mortality than total or peripheral fat. However, there has been a controversy whether obesity is a risk factor of death in end-stage renal disease (ESRD) patients because several survival studies suggested that a higher body mass index (BMI), a marker of obesity, is associated with an improved survival.Several studies suggested that abdominal fat deposition is associated with an increased mortality risk in hemodialysis patients, like in general population. Peritoneal dialysis (PD) patients seemed to have more abdominal obesity than HD patients. However, there are few data in PD patients. In the present study, we examined the influence of abdominal obesity on the survival of PD patient.Part oneThe relationship between abdominal obesity and mortality in continuous ambulatory peritoneal dialysis patientsAbjective:Study the relationship between abdominal obesity (AO) and mortality in peritoneal dialysis (PD) patients.Methods:This retrospective study was performed on ESRD patients on CAPD who had been followed up at the outpatient PD clinic, Inha University Hospital in Incheon, Korea. The prevalence of AO in 130 PD patients was assessed in a cross-section manner and followed up for 9 years in a single center. The patients were classified as either with AO (AO group) or without AO (nAO group)(AO was defined as a WC greater than 90 cm in males or greater than 80 cm in females). The patients were also classified as 4 groups according to sex and diabetes mellitus (DM). The overall patient survival was estimated using the Kaplan-Meier method; Mortality was analyzed using the multivariate Cox’s proportional hazard model.Results:The mean age of the subjects was 51±12years. The male to female ratio was 1:1.4. Thirty percent of the patients were diabetics. Among the 130 patients, the number of AO subjects was 71(54.6%). The AO group was older (55±10 vs.46±13, P< 0.001), had more diabetics (39.4% vs. 18.6%, p=0.01), more females(70.4% vs.42.4%, p=0.001), and had higher Charlson comorbidity index (aCCI) scores (3.8±1.4 vs.3.0±1.4, p=0.002), BMI (25.4±3.0 vs.21.6±2.7,P< 0.001), total cholesterol (200±53 vs.183±36, P=0.039), and triglyceride (179±121 vs.120±49, P=0.001) than the non-AO subjects. The follow-up duration was 53,3±33.3 months. The five year survival rate was 40.8%. Kaplan-Meier analysis revealed that both all-cause and cardiovascular-cause mortalities were similar in the AO and nAO groups. Multivariate analysis revealed group according to sex and DM, aCCI score, and BMI to be independent risk factors of all-cause mortality. The all-cause and cardiovascular-cause mortality analyses revealed female non-diabetics to have the highest survival rate among the 4 groups.Conclusion:AO itself might not be a risk factor for mortality in PD patients. Nevertheless, further prospective studies with a large number of patients will be needed to prove this. 18.6%, p=0.01), more females(70.4% vs.42.4%, p=0.001), and had higher Charlson comorbidity index (aCCI) scores (3.8±1.4 vs.3.0±1.4, p=0.002), BMI (25.4±3.0 vs.21.6±2.7,P< 0.001), total cholesterol (200±53 vs.183±36, P=0.039), and triglyceride (179±121 vs.120±49, P=0.001) than the non-AO subjects. The follow-up duration was 53,3±33.3 months. The five year survival rate was 40.8%. Kaplan-Meier analysis revealed that both all-cause and cardiovascular-cause mortalities were similar in the AO and nAO groups. Multivariate analysis revealed group according to sex and DM, aCCI score, and BMI to be independent risk factors of all-cause mortality. The all-cause and cardiovascular-cause mortality analyses revealed female non-diabetics to have the highest survival rate among the 4 groups.Conclusion:AO itself might not be a risk factor for mortality in PD patients. Nevertheless, further prospective studies with a large number of patients will be needed to prove this.Part twoAssociation between conicity index and survival in peritoneal dialysis patientsObjective:To elaluate the association between conicity index and survial in peritoneal dialysis (PD) patients.Methods:This retrospective study was performed on ESRD patients on CAPD who had been followed up at the outpatient PD clinic, Inha University Hospital in Incheon, Korea. The prevalence of AO in 130 PD patients was assessed in a cross-section manner and followed up for 9 years in a single center.The conicity index(CI), waist circumference/[0.109×square root of (weight/height)], was used as a parameter of abdominal obesity. Patients were classified according to the percentile of CI [Low CI group (<1.217), Middle CI group (1.217-1.332), High CI group (>1.332)。PEW was evaluated SGA,S-creatinine was putatively a surrogate marker of muscle mass). The overall patient survival was estimated using the Kaplan-Meier method; Mortality was analyzed using the multivariate Cox’s proportional hazard model.Results:Mean CI was 1.27±0.13 (range 0.50-1.54). In high CI group,13 were severely malnourished and reduced levels of S-creatinine compared with low CI group and middle CI group S-creatinine (mg/dL) (8.6±3.9 vs 11.4±4.0 vs 9.6±3.3, P=0.007); aCCI score (4.3±1.5 vs 2.7±1. vs 3.4±1.4, P<0.001); WC (cm) (93.1±5.5 vs 75.1±12.4 vs 86.1±6.7, P< 0.001); WHR (0.95±0.07 vs 0.87±0.06 vs 0.92±0.05, P< 0.001); Twelve died of cerebral infarction or cardiovascular disease. Five year survival rate was 40.8%. Kaplan-Meier analysis revealed that 5-year survival rate was significantly lower in high CI group than in low CI group (23.3% vs.53.3 p=0.01). In multivariate analysis adjusted for age-adjusted CCI score, serum albumin, hemoglobin, body mass index, subjective global assessment group, sex and previous peritonitis rate, increased C was an independent risk factor of all-cause mortality [hazard ratio (HR) 5.43,95% confidence interval (CI) 1.16-25.4 in group 2; HR 14.98,95% CI 2.73-82.24 in group 3] and CVD mortality [HR 19.82,95% CI 2.13-184.2 in group 3].Conclusion:Increased CI have poorer outcome in CAPD patients,Increased abdominal fat deposition in CAPD patients is linked to PEW.