Obesity paradox in end-stage kidney disease patients

Jongha Park, Seyed Foad Ahmadi, Elani Streja, Miklos Z. Molnar, Katherine M. Flegal, Daniel Gillen, Csaba Kovesdy, Kamyar Kalantar-Zadeh

Research output: Contribution to journalArticle

145 Citations (Scopus)

Abstract

In the general population, obesity is associated with increased cardiovascular risk and decreased survival. In patients with end-stage renal disease (ESRD), however, an "obesity paradox" or "reverse epidemiology" (to include lipid and hypertension paradoxes) has been consistently reported, i.e. a higher body mass index (BMI) is paradoxically associated with better survival. This survival advantage of large body size is relatively consistent for hemodialysis patients across racial and regional differences, although published results are mixed for peritoneal dialysis patients. Recent data indicate that both higher skeletal muscle mass and increased total body fat are protective, although there are mixed data on visceral (intra-abdominal) fat. The obesity paradox in ESRD is unlikely to be due to residual confounding alone and has biologic plausibility. Possible causes of the obesity paradox include protein-energy wasting and inflammation, time discrepancy among competitive risk factors (undernutrition versus overnutrition), hemodynamic stability, alteration of circulatory cytokines, sequestration of uremic toxin in adipose tissue, and endotoxin-lipoprotein interaction. The obesity paradox may have significant clinical implications in the management of ESRD patients especially if obese dialysis patients are forced to lose weight upon transplant wait-listing. Well-designed studies exploring the causes and consequences of the reverse epidemiology of cardiovascular risk factors, including the obesity paradox, among ESRD patients could provide more information on mechanisms. These could include controlled trials of nutritional and pharmacologic interventions to examine whether gain in lean body mass or even body fat can improve survival and quality of life in these patients.

Original languageEnglish (US)
Pages (from-to)415-425
Number of pages11
JournalProgress in Cardiovascular Diseases
Volume56
Issue number4
DOIs
StatePublished - Jan 1 2014

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Chronic Kidney Failure
Obesity
Adipose Tissue
Survival
Epidemiology
Overnutrition
Intra-Abdominal Fat
Body Size
Peritoneal Dialysis
Endotoxins
Malnutrition
Lipoproteins
Renal Dialysis
Dialysis
Skeletal Muscle
Body Mass Index
Hemodynamics
Quality of Life
Cytokines
Hypertension

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Park, J., Ahmadi, S. F., Streja, E., Molnar, M. Z., Flegal, K. M., Gillen, D., ... Kalantar-Zadeh, K. (2014). Obesity paradox in end-stage kidney disease patients. Progress in Cardiovascular Diseases, 56(4), 415-425. https://doi.org/10.1016/j.pcad.2013.10.005

Obesity paradox in end-stage kidney disease patients. / Park, Jongha; Ahmadi, Seyed Foad; Streja, Elani; Molnar, Miklos Z.; Flegal, Katherine M.; Gillen, Daniel; Kovesdy, Csaba; Kalantar-Zadeh, Kamyar.

In: Progress in Cardiovascular Diseases, Vol. 56, No. 4, 01.01.2014, p. 415-425.

Research output: Contribution to journalArticle

Park, J, Ahmadi, SF, Streja, E, Molnar, MZ, Flegal, KM, Gillen, D, Kovesdy, C & Kalantar-Zadeh, K 2014, 'Obesity paradox in end-stage kidney disease patients', Progress in Cardiovascular Diseases, vol. 56, no. 4, pp. 415-425. https://doi.org/10.1016/j.pcad.2013.10.005
Park J, Ahmadi SF, Streja E, Molnar MZ, Flegal KM, Gillen D et al. Obesity paradox in end-stage kidney disease patients. Progress in Cardiovascular Diseases. 2014 Jan 1;56(4):415-425. https://doi.org/10.1016/j.pcad.2013.10.005
Park, Jongha ; Ahmadi, Seyed Foad ; Streja, Elani ; Molnar, Miklos Z. ; Flegal, Katherine M. ; Gillen, Daniel ; Kovesdy, Csaba ; Kalantar-Zadeh, Kamyar. / Obesity paradox in end-stage kidney disease patients. In: Progress in Cardiovascular Diseases. 2014 ; Vol. 56, No. 4. pp. 415-425.
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