Abstract: FR-PO859

Impact of the Obesity Epidemic on Dialysis Patients

Session Information

Category: Dialysis

  • 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular

Authors

  • McGill, Rita L., University of Chicago, Chicago, Illinois, United States
  • Gupta, Varun, Creighton University, Northbrook, Illinois, United States
  • Meyer, Klemens B., Tufts Medical Center, Boston, Massachusetts, United States
Background

Obesity promotes chronic kidney disease directly via glomerular hyperfiltration, indirectly via increased diabetes and cardiovascular disease, and may reduce the likelihood of dying prior to kidney failure. We examined the impact of the US obesity epidemic on body mass index (BMI) of incident dialysis patients.

Methods

Cohorts of all incident adult USRDS patients between 2005 and 2015 with values recorded for BMI were examined, with stratification for hemodialysis (HD) and peritoneal dialysis (PD). BMI in kg/m2 was categorized as <25, 25-29.9, 30-34.9, 35-39.9, and >=40. Age, race, sex, and end-stage renal disease (ESRD) network were also recorded. Multivariable linear regression was used to estimate the change in BMI over time separately for HD and PD patients.

Results

Among 1,007,774 incident HD patients and 78,745 incident PD patients, the proportions of patients with BMI<25 decreased, the proportions of patients with BMI 25-29.99 were stable, and the proportions of all groups with BMI>30 increased between 2005 and 2015. After adjustment for age, sex, ESRD network, and race, BMI at dialysis initiation increased 0.147 kg/m2 per year in HD patients and 0.126 kg/m2 in PD patients (P<0.0001 for both).

Conclusion

Obesity and morbid obesity have been slowly increasing in the US dialysis population. Depending upon transplantation center criteria, 10-20% of patients enter dialysis with a BMI too high to be considered for kidney transplantation. Despite the paradoxical effects on survival, increasing obesity threatens the health of the dialysis patients, who face increased co-morbid disease burdens, reduced opportunities for optimal vascular access, and lower likelihoods that PD clearance will be adequate.

Distribution of BMI in Patients on HD and PD over Time