Obesity and Mortality in End-Stage Renal Disease. Is It Time to Reverse the "Reverse Epidemiology"-at Least in Peritoneal Dialysis?

With the rising incidence of chronic kidney disease, there has been a steady growth of the hemodialysis (HD) and peritoneal dialysis (PD) population. Prevalence of obesity has also been on the rise. It has been proposed by some that obesity helps with survival in HD and possibly in PD patients-a concept called "Reverse Epidemiology." Here, we attempt to explore this phenomenon in the HD and PD populations and see specifically if it is time to reverse this concept. A MEDLINE search was performed using search terms: obesity, body mass index, end-stage renal disease, HD, PD, renal dialysis, mortality, survival, and reverse epidemiology. Review of recent literature questions the benefit of obesity on survival in the dialysis population-more specifically in PD. Patients on PD with higher muscle mass seem to have the best survival. There should be more focus on malnutrition among such patients.