"Obesity Paradox": Obesity may increase survival in advanced chronic kidney disease

"Obesity Paradox" again: Obesity may increase survival in advanced chronic kidney disease, finds a new study.

Obesity is one of the major global health menaces that can lead to a number of health issues such as diabetes, cardiovascular disease, liver disorders, and kidney disorders. Despite the comorbidities associated with it, obesity may be advantageous for the survival of patients suffering from advanced chronic kidney disease or end-stage renal disease ESRD, who are on dialysis, said a professor of Perelman School of Medicine during a presentation at the National Kidney Foundation Spring Clinical Meetings.

The speaker stated that while obesity does not benefit patients with nondialysis-dependent CKD, being thin may worsen the mortality risk than being obese for patients on dialysis.

Explaining the reason for the survival rate being multifaceted in ESRD patients, the speaker said that a greater caloric reserve may compensate for the restrictive diet making the patients resistant to weight loss. Weight loss increases the mortality risk in these patients. Therefore, being overweight may increase the survival of ESRD patients.

Furthermore, the speaker stated that while obesity increases long-term cardiovascular mortality, it may attenuate short-term mortality associated with malnutrition, inflammation, and protein-energy wasting which in turn is advantageous for ESRD patients. She explained that obese patients are more resistant to protein-energy wasting and cachexia, which is a leading cause of organ dysfunction and death among these patients.

The speaker acknowledged that even though in this case there is an obesity paradox but the comorbidities associated with it still can not be ignored regardless of any survival paradox.

The author acknowledged that the data showing an association between obesity and kidney disease and obesity are limited due to reliance on the BMI as the only measure of obesity. Therefore, it can be assumed that the reduced risk of mortality in these patients may not be due to obesity rather increased the mass of fat.

Obesity is not only a major cardiovascular risk factor but also an important element in the development of a wide range of chronic kidney diseases (CKD). The importance of obesity in the pathogenesis of CKD is so high that the 2016 World Kidney Day was dedicated to this issue. Obesity has a dual meaning in advanced CKD. On one hand, when dialysis is started, clinicians and patients are faced with what is called in this case the obesity paradox—a survival advantage in obese patients on dialysis, on the other hand, it can be fatal for nondialysis CKD patients.

While obesity increases long-term cardiovascular mortality, it may attenuate short-term mortality associated with malnutrition, inflammation, and protein-energy wasting which in turn can increase the survival of ESRD patients.

For further reference log on to:

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