Obesity rates increasing for patients on peritoneal dialysis in China
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The prevalence of obesity has increased for patients initiating peritoneal dialysis in China during the past 25 years, research published in the Clinical Kidney Journal revealed.
The finding was most pronounced for patients who had diabetes before kidney failure, with researchers also observing greater rates of new-onset diabetes after dialysis initiation for patients with obesity or who were overweight.
Impact of weight
“In many developed countries, population changes in age, obesity and diabetes prevalence, and [end-stage kidney disease] ESKD survival are believed to be the major causes of the increasing prevalence of ESKD. Notably, the prevalence of obesity has increased in the general population over the past [2] decades,” Win Hlaing Than, MD, of the Carol and Richard Yu Peritoneal Dialysis Research Centre, department of medicine and therapeutics, Prince of Wales Hospital in Hong Kong, and colleagues wrote. “Although the prevalence of obesity is highest in America, Europe, and the Eastern Mediterranean region, urbanization of rural areas results in an increase in the prevalence of obesity in many countries. In China, the prevalence of obesity rose from 6.5% in 1997 to 14.8% in 2011, and the prevalence of overweight rose from 29.1% to 41% during that period.”
Hlaing Than and colleagues suggested that the “complicated interaction” between chronic kidney disease and weight — the observed link between higher BMI and the development of CKD existing concurrently with evidence showing CKD leads to malnutrition and progressive weight loss, for example — has resulted in the relationship being understudied.
To remedy this, the researchers reviewed the anthropomorphic measures of 1,681 patients (mean age was 58.4 years; 55.4% had preexisting diabetes) who initiated peritoneal dialysis (PD) at a center in Hong Kong between 1995 and 2019.
Results of the retrospective study showed the prevalence of obesity or overweight at PD initiation increased progressively for every 5-year period during the 25-year timeframe (specifically, prevalence rose from 21.9% to 26.2% between 1995 and 2000; from 26.2% to 37.9% between 2000 and 2005; from 37.9% to 42.7% between 2005 and 2010; and from 42.7% to 47.3% between 2010 and 2015 to 2019).
Preexisting, new-onset diabetes
Further, the increase in the prevalence of obesity or overweight was more pronounced in patients who also had diabetes than those who did not, with rates increasing from 33.7% to 59.6% in the former cohort vs. 13.2% to 32.3% in the latter.
For the group of patients who did not have diabetes at PD initiation, researchers observed a trend toward rising rates of new-onset diabetes during the 25-year period (from 18% to 23.3%), with patients who had obesity or overweight showing a higher incidence of either new-onset diabetes or impaired fasting glucose than those without obesity or overweight (56.9% vs. 51.4%).
The observation that new-onset diabetes was significantly more common in patients who had preexisting obesity led Hlaing Than and colleagues to suggest that the increasing prevalence of obesity explains the increase.
“Although the prognostic impact of obesity in PD patients has been examined by multiple groups, the prevalence and impact of body weight change after started on PD have not been extensively studied,” the researchers concluded. “The complex interactions between body fat mass, fluid accumulation, and cardiovascular disease of PD patients also deserve further study.”
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