CARDIOVASCULAR AND SURVIVAL PARADOXES IN DIALYSIS PATIENTS: Obesity‐Survival Paradox—Still a Controversy?

@article{Schmidt2007CARDIOVASCULARAS,
  title={CARDIOVASCULAR AND SURVIVAL PARADOXES IN DIALYSIS PATIENTS: Obesity‐Survival Paradox—Still a Controversy?},
  author={Darren S Schmidt and Abdulla K. Salahudeen},
  journal={Seminars in Dialysis},
  year={2007},
  volume={20}
}
Since the original description of the obesity‐survival paradox in 1999, which suggested a survival advantage for overweight and obese patients undergoing hemodialysis, a large body of evidence supporting the paradox has accumulated. The reason for the paradox has yet to be defined. Better nutrition may be a partial explanation, or it may be that in uremic milieu, excessive fat and surplus calories might confer some survival advantage. The “surplus calorie theory” as a potential mechanism for… Expand

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References

SHOWING 1-10 OF 50 REFERENCES
Effect of obesity on PD versus HD survival: is caloric intake the discriminating factor?
TLDR
The higher caloric intake by dialysis patients for many conceivable reasons may contribute to longer survival, and this may help to explain why nonobese patients on peritoneal dialysis may not display any less survival advantage compared with their obese counterparts. Expand
The obesity-survival paradox in hemodialysis patients: why do overweight hemodialysis patients live longer?
  • Darren S Schmidt, A. Salahudeen
  • Medicine
  • Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition
  • 2007
TLDR
The available data are reviewed and potential reasons for the obesity-survival paradox in the dialysis population are provided, which are not universally accepted nor completely understood. Expand
Obesity and survival on dialysis.
  • A. Salahudeen
  • Medicine
  • American journal of kidney diseases : the official journal of the National Kidney Foundation
  • 2003
TLDR
The literature on the association between body mass and dialysis survival and the possible mechanistic and clinical implications are examined. Expand
Association of body size with outcomes among patients beginning dialysis.
TLDR
High BMI is not associated with increased mortality among patients beginning dialysis and this finding does not appear to be a function of lean body mass and, although modified by certain patient characteristics, it is a robust finding. Expand
Is Obesity a Favorable Prognostic Factor in Peritoneal Dialysis Patients?
  • D. Johnson, K. Herzig, +6 authors C. Hawley
  • Medicine
  • Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis
  • 2000
TLDR
Obese patients should not be discouraged from receiving peritoneal dialysis purely on the basis of BMI, and maintaining a higher-than-average BMI to preserve “nutritional reserve” may help to reduce the mortality and morbidity rates associated with PD. Expand
Association of morbid obesity and weight change over time with cardiovascular survival in hemodialysis population.
TLDR
Weight gain and both baseline and time-varying obesity may be associated with reduced cardiovascular mortality in MHD patients independent of laboratory surrogates of nutritional status and their changes over time. Expand
Overweight as another nutritional risk factor for the long-term survival of non-diabetic hemodialysis patients.
TLDR
The results suggest that long-term survival could be attained by patients with relatively low BMI who have no serious nutritional problems and Nutritional intervention might be required in the overweight patients, in addition to extremely lean patients. Expand
Annual fat mass change is a significant predictor of mortality in female hemodialysis patients.
TLDR
It is demonstrated that the decrease in annual fat mass is a significant predictor for mortality in female hemodialysis patients and is also a useful parameter for measurement of nutritional status in hemodIALysis patients. Expand
Influence of nutritional factors and hemodialysis adequacy on the survival of 1,610 French patients.
TLDR
Results indicate that nutritional protein concentrations were predictive of dialysis outcome, whereas variables reflecting actual body composition and dialysis dose were not, and in this well-dialyzed population, dialysis adequacy had no influence on survival. Expand
Simple nutritional indicators as independent predictors of mortality in hemodialysis patients.
TLDR
Serum albumin was confirmed to be a useful predictor of mortality risk in hemodialysis patients; BMI was established as an independently important predictor ofortality; both serum albumin and BMI, measured at baseline, continue to possess predictive value 5 years later; the subjective caregiver classification of nutritional status "undernourished" has independent value in predicting mortality risk beyond the information gained from two other markers of nutritionalStatus. Expand
...
1
2
3
4
5
...