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Effect of obesity on PD versus HD survival: is caloric intake the discriminating factor?

Shariq Ahmad,A. Salahudeen

Published 2004 in Kidney International

ABSTRACT

To the Editor: Higher body mass index (BMI) and its positive association with dialysis patients’ survival has become an area of interest [1]. Abbott et al [2] have recently published an article suggesting that any paradoxical survival advantage observed with obesity in hemodialysis (HD) patients may not be seen in patients on peritoneal dialysis (PD). This contradicts an earlier report by Snyder et al [3], but Abbott et al’s finding is probably more reflective of the long-term. If the finding by Abbott et al is to be confirmed (i.e., obesity in PD is not associated with any long-term survival advantage), then one has to ask the interesting question as to why there may be a “paradox within paradox?” We would like to propose an intriguing and plausible hypothesis that involves difference in the caloric intake. In general, all PD patients, obese or nonobese, employ 1.5% to 4.25% of dextrose in their dialysate, often around the clock, that is estimated to be absorbed at 45% [4]. In contrast, HD patients are exposed to 1% of dextrose in their dialysate during the 4-hour, thrice weekly dialysis. Therefore, the higher caloric intake, rather than obesity, per se, may account for the better survival of dialysis patients, and this may help to explain why nonobese patients on PD may not display any less survival advantage compared with their obese counterparts (Fig. 1). A higher caloric intake by dialysis patients for many conceivable reasons may contribute to longer survival. Anyone for a controlled trial?

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