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‘Obesity paradox’: Patients with ESRD, obesity may have reduced risk for mortality

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Jordana Cohen

BOSTON — For patients with ESRD, also having obesity may provide a survival benefit, leading to what a speaker at the National Kidney Foundation Spring Clinical Meetings has termed an “obesity paradox.”

“Obviously, obesity is a world-wide public health crisis,” Jordana Cohen, MD, MSCE, assistant professor of medicine and epidemiology in the renal-electrolyte and hypertension division at the Perelman School of Medicine at the University of Pennsylvania, said in a presentation. “Obesity is associated with an increased risk for diabetes, hypertension, CKD and ESRD in the general population. [However], we actually see a mortality benefit to being obese in individuals who already have ESRD.”

While there is no benefit to having obesity for patients with nondialysis-dependent CKD, Cohen argued that, for patients on dialysis, being thin is “much worse” in terms of mortality risk than being obese. The reason for this survival benefit is multifaceted, she said, and is partly due to the fact that patients with obesity have a greater caloric reserve which helps counterbalance the restrictive diet, making them more resistant to weight loss and causing them to live longer. These patients are also more resistant to protein-energy wasting and cachexia which can lead to multiple organ dysfunction and, ultimately, death.

“It’s important to keep in mind that, even if there is an obesity paradox, there’s still great comorbidity and important health risks associated with obesity that can’t be ignored regardless of any potential survival paradox,” Cohen said.

She also added that, as studies are limited due to reliance on BMI as the only metric for obesity, the reduced risk for mortality may not be about the “obesity itself but, rather, increased fat mass, particularly central fat mass.” – by Melissa J. Webb

Reference:

Cohen J. A growing problem: Obesity in CKD and transplantation. Presented at: National Kidney Foundation Spring Clinical Meetings; May 8-12, 2019; Boston.

Disclosure: Cohen reports no relevant financial disclosures.