Profile of Obesity and Comorbidities and their Correlation among Hemodialysis Patients, Elbasan

Authors

  • Brunilda Elezi University “Aleksander Xhuvani”, Faculty of Technical Medical Science, Elbasan, Albania
  • Skender Topi Rectors of “Aleksander Xhuvani” University of Elbasan, Albania, Chief of Surgery Department, Professor of Faculty of Technical Medical Sciences, “Aleksander Xhuvani” University, Elbasan, Albania
  • Erjona Abazaj Institute of Public Health, Tirana, Albania https://orcid.org/0000-0003-2386-4605

DOI:

https://doi.org/10.3889/oamjms.2022.7519

Keywords:

Body mass index, Correlation, Hemodialysis, Survival, Morbidity

Abstract

INTRODUCTION: Nowadays, obesity is an enormous problem in the public health of undeveloped countries and developing countries. Being overweight, especially obesity in internal organs contributes to increased risk of metabolic and cardiovascular complications in patients with chronic kidney disease. There is no complete data available in our country on the correlation between obesity and comorbidity diseases among persons undergoing dialysis. So we do not know how BMI affects Diabetic or Cardio Vascular Disease (CVD) patients among dialysis patients. We, therefore, undertook this study to evaluate the association of obesity with mobility in hemodialysis patients at the Elbasan dialysis center.

METHODOLOGY: This cross-sectional study was performed in 160 patients who have undergone the dialysis process at Elbasan Dialysis Center for three years (2016-2018). A standardized questionnaire was adopted to obtain data from all patients. The subjects were divided a priory into 4 categories based on the body mass index (BMI) (underweight <19, normal 19-25, pre-obese 25-30 and obese ≥30 kg/m2). Software SPSS version 20.0 is used to analyze and evaluate the data. Kaplan-Meier estimate were used to find the correlation between BMI with their prognostic abilities like cardiovascular disease and Diabetes Mellitus Type 2. We have considered statistically significant every p value less than 0.05.

RESULT: Over all 160 patients, the men presented the highest number of cases compared to female 73.1% and 26.9% respectively. The mean age resulted 52.7 ± 15.6 years and age groups 50-59 years old and 60-69 years old with 29.4% and 34.3% respectively were the most frequent in this study. About the category of BMI index 8.8% patients resulted underweight, 45% were in normal weight, 28.2% were pre-obese and 6.6% were obese. We observed significant correlations between BMI and some of the demographic data such as: gender, age, place of residence, educational level, smoking and alcohol consumption for p <0.05. Changes in patient survival rates between BMI with DMT2 and cardiovascular disease are not statistically significant (long range p> 0.05). In terms of mortality, a strong significant correlation was observed with the age of 50-69 years and with the index of hemoglobin, urea and creatinine after dialysis with p value <0.05.

CONCLUSION: In the paradoxical epidemiology, the overweight becomes chronic on hemodialysis patients and serves as a protective factor which is associated with better survival, but we weren`t found significant association between the BMI and some of the variables analyzed. This study presents a small number of chronic patients on hemodialysis center in Elbasan city. There is a need to better understand the reverse epidemiological causes in individuals on dialysis, which can help us improve the poor outcome in this population.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Park JM, Lee JH, Jang HM, Park Y, Kim YS, Kang SW, et al. Survival in patients on hemodialysis: Effect of gender according to body mass index and creatinine. PLoS One. 2018;13(5):e0196550. https://doi.org/10.1371/journal.pone.0196550 PMid:29768438 DOI: https://doi.org/10.1371/journal.pone.0196550

Beberashvili I, Azar A, Abu Hamad R, Sinuani I, Feldman L, Maliar A, et al. Abdominal obesity in normal weight versus over weight and obese hemodialysis patients: Associations with nutrition, inflammation, muscle strength, and quality of life. Nutrition. 2018;59:7-13. https://doi.org/10.1016/j.nut.2018.08.002 PMid:30415161 DOI: https://doi.org/10.1016/j.nut.2018.08.002

Gorsane I, Mahfoudhi M, El Euch M, Younsi F, Abdallah TB. Obesity in hemodialysis patients. Int J Clin Med. 2015;6:667-71. https://doi.org/10.4236/ijcm.2015.69089 DOI: https://doi.org/10.4236/ijcm.2015.69089

Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath CW Jr. Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med. 1999;341(15):1097-105. https://doi.org/10.1056/NEJM199910073411501 PMid:10511607 DOI: https://doi.org/10.1056/NEJM199910073411501

Vashistha T, Mehrotra R, Park J, Streja E, Dukkipati R, Nissenson AR, et al. Effect of age and dialysis vintage on obesity paradox in longterm hemodialysis patients. Am J Kidney Dis 2014;63(4):612-22. https://doi.org/10.1053/j.ajkd.2013.07.021 PMid:24120224 DOI: https://doi.org/10.1053/j.ajkd.2013.07.021

Stevens J, Cai J, Pamuk ER, Williamson DF, Thun MJ, Wood JL. The effect of age on the association between body-mass index and mortality. N Engl J Med. 1998;338(1):1-7. https://doi.org/10.1056/NEJM199801013380101 PMid:9414324 DOI: https://doi.org/10.1056/NEJM199801013380101

Grabowski DC, Ellis JE. High body mass index does not predict mortality in older people: Analysis of the longitudinal study of aging. J Am Geriatr Soc. 2001;49(7):968-79. https://doi.org/10.1046/j.1532-5415.2001.49189.x PMid:11527490. DOI: https://doi.org/10.1046/j.1532-5415.2001.49189.x

Oreopoulos A, Kalantar-Zadeh K, Sharma AM, Fonarow GC. The obesity paradox in the elderly: Potential echanisms and clinical implications. Clin Geriatr Med. 2009;25(4):643-59. viii. https://doi.org/10.1016/j.cger.2009.07.005 PMid:19944265. DOI: https://doi.org/10.1016/j.cger.2009.07.005

Oreopoulos A, Padwal R, Kalantar-Zadeh K, Fonarow GC, Norris CM, McAlister FA. Body mass index and mortality in heart failure: A meta-analysis. Am Heart J. 2008;156(1):13-22. https://doi.org/10.1016/j.ahj.2008.02.014 PMid:18585492. DOI: https://doi.org/10.1016/j.ahj.2008.02.014

Oreopoulos A, Ezekowitz JA, McAlister FA, Kalantar-Zadeh K, Fonarow GC, Norris CM, et al. Association between direct measures of body composition and rognostic factors in chronic heart failure. Mayo Clin Proc. 2010;85(7):609-17. https://doi.org/10.4065/mcp.2010.0103 PMid:20592169 DOI: https://doi.org/10.4065/mcp.2010.0103

Freitas AT, Vaz IM, Ferraz SF, Mdo RP, Campos MI, Fornés NS. Prevalence and associated factors with abdominal obesity in

hemodialysis patients in Goiânia. J Bras Nefrol. 2013;35:265-72. https://doi.org/10.5935/0101-2800.20130045 DOI: https://doi.org/10.5935/0101-2800.20130045

Yang SY, Chiang CK, Hsu SP, Peng YS, Pai MF, Ho TI, et al. Metabolic syndrome predicts hospitalization in hemodialysis patients: A prospective Asian cohort study. Blood Purif 2007;25(3):252-9. https://doi.org/10.1159/000101698 PMid:17429199 DOI: https://doi.org/10.1159/000101698

National Kidney Foundation. K/DOQI clinical practice guidelines for nutrition in chronic renal failure. Am J Kidney Dis. 2000;35(6 Suppl 2):S1-140. https://doi.org/10.1053/ajkd.2000.v35.aajkd03517 PMid:10895784 DOI: https://doi.org/10.1053/ajkd.2000.v35.aajkd03517

Kalantar-Zadeh K, Kopple JD, Kilpatrick RD, McAllister CJ, Shinaberger CS, Gjertson DW, et al. Association of morbid obesity and weight change over time with cardiovascular survival in hemodialysis population. Am J Kidney Dis. 2005;46(3):489-500. https://doi.org/10.1053/j.ajkd.2005.05.020 PMid:16129211 DOI: https://doi.org/10.1053/j.ajkd.2005.05.020

Kalantar-Zadeh K, Kuwae N, Wu DY, Shantouf RS, Fouque D, Anker SD, et al. Associations of body fat and its changes over time with quality of life and prospective mortality in hemodialysis patients. Am J Clin Nutr. 2006;83(2):202-10. https://doi.org/10.1093/ajcn/83.2.202 PMid:16469976 DOI: https://doi.org/10.1093/ajcn/83.2.202

Kalantar-Zadeh K, Streja E, Molnar MZ, Lukowsky LR, Krishnan M, Kovesdy CP, et al. Mortality prediction by surrogates of body composition: An examination of the obesity paradox in hemodialysis patients using composite ranking score analysis. Am J Epidemiol. 2012;175(8):793-803. PMid:22427612 DOI: https://doi.org/10.1093/aje/kwr384

Johansen KL, Young B, Kaysen GA, Chertow GM. Association of body size with outcomes among patients beginning dialysis. Am J Clin Nutr. 2004;80(2):324-32. https://doi.org/10.1093/ajcn/80.2.324 PMid:15277152 DOI: https://doi.org/10.1093/ajcn/80.2.324

Ricks J, Molnar MZ, Kovesdy CP, Kopple JD, Norris KC, Mehrotra R, et al. Racial and ethnic differences in the association of body mass index and survival in maintenance hemodialysis patients. Am J Kidney Dis. 2011;58(4):574-82. https://doi.org/10.1053/j.ajkd.2011.03.023 PMid:21658829 DOI: https://doi.org/10.1053/j.ajkd.2011.03.023

Lievense H, Kalantar-Zadeh K, Lukowsky LR, Molnar MZ, Duong U, Nissenson A, et al. Relationship of body size and initial dialysis modality on subsequent transplantation, mortality and weight gain of ESRD patients. Nephrol Dial Transplant. 2012;27(9):3631-8. https://doi.org/10.1093/ndt/gfs131 PMid:22553372 DOI: https://doi.org/10.1093/ndt/gfs131

Panzetta G, Abaterusso C. Obesity in dialysis and reverse epidemiology: True or false? G Ital Nefrol 2010;27(6):629-38. PMid:21132645

Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999-2000. JAMA. 2002;288(14):1723-7. https://doi.org/10.1001/jama.288.14.1723 PMid:12365955 DOI: https://doi.org/10.1001/jama.288.14.1723

World Health Organization. Obesity and Overweight Fact Sheet. Geneva: World Health Organization; 2017. Available from: http://www.who.int/news-room/fact-sheets/detail/obesity-andoverweight [Last accessed on 2021 Aug 12].

Asiki G, Mohamed SF, Wambui D, Wainana C, Muthuri S, Ramsay M. Sociodemographic and behavioural factors associated with body mass index among men and women in Nairobi slums: AWI-Gen project. Glob Health Action.

;11(2):1470738. https://doi.org/10.1080/16549716.2018.1470738 PMid:29966508 DOI: https://doi.org/10.1080/16549716.2018.1470738

Kramer HJ, Saranathan A, Luke A, Durazo-Arvizu RA, Guichan C, Hou S, et al. Increasing Body Mass Index and obesity in the incident ESRD population. J Am Soc Nephrol. 2006;17(5):1453-9. https://doi.org/10.1681/ASN.2005111241 PMid:16597682 DOI: https://doi.org/10.1681/ASN.2005111241

Xue JL, Ma JZ, Louis TA, Collins AJ. Forecast of the number of patients with end-stage renal disease in the United States to the year 2010. J Am Soc Nephrol 2016;12(12):2753-8. https://doi.org/10.1681/ASN.V12122753 PMid:11729245 DOI: https://doi.org/10.1681/ASN.V12122753

Peer N, Kengne AP, Motala AA, Mbanya JC. Diabetes in the Africa Region: 2013 Update for the IDF Diabetes Atlas; 2013.

Twagirumukiza M, De Bacquer D, Kips JG, de Backer G, Vander Stichele R, Van Bortel LM. Current and projected prevalence of arterial hypertension in sub-Saharan Africa by sex, age and habitat: An estimate from population studies. J Hypertens. 2011;29(7):1243-52. https://doi.org/10.1097/HJH.0b013e328346995d PMid:21540748 DOI: https://doi.org/10.1097/HJH.0b013e328346995d

Jha V, Garcia-Garcia G, Iseki K, Li Z, Naicker S, Plattner B, et al. Chronic kidney disease: Global dimension and perspectives. Lancet. 2013;382(9888):260-72. https://doi.org/10.1016/S0140-6736(13)60687-X PMid:23727169 DOI: https://doi.org/10.1016/S0140-6736(13)60687-X

Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: A systematic analysis for the global burden of disease study 2010. Lancet. 2013;380(9859):2095-128. https://doi.org/10.1016/S0140-6736(12)61728-0 PMid:23245604 DOI: https://doi.org/10.1016/S0140-6736(12)61728-0

Basu R, Man CD, Campioni M, Basu A, Klee G, Toffolo G, et al. Effects of age and sex on postprandial glucose metabolism: Differences in glucose turnover, insulin secretion, insulin action, and hepatic insulin extraction. Diabetes. 2006;55(7):2001-14. https://doi.org/10.2337/db05-1692 PMid:16804069 DOI: https://doi.org/10.2337/db05-1692

Veloso HJ, Silva AA. Prevalence and factors associated with abdominal obesity and overweight in adults from Maranhão. Rev Bras Epidemiol 2010;13:400-12. DOI: https://doi.org/10.1590/S1415-790X2010000300004

Linhares RS, Horta BL, Gigante DP, Dias-da-Costa JS, Olinto MT. Distribution of general and abdominal obesity in adults in a city in southern Brazil. Cad Saúde Pública. 2012;28:438-48. DOI: https://doi.org/10.1590/S0102-311X2012000300004

Postorino M, Marino C, Tripepi G, Zoccali C; CREDIT (Calabria Registry of Dialysis and Transplantation) Working Group. Abdominal obesity and all-cause and cardiovascular mortality in end-stage renal disease. J Am Coll Cardiol 2009;53(15):1265-72. https://doi.org/10.1016/j.jacc.2008.12.040 PMid:19358939 DOI: https://doi.org/10.1016/j.jacc.2008.12.040

Elsayed EF, Sarnak MJ, Tighiouart H, Griffith JL, Kurth T, Salem DN, et al. Waist-to-hip ratio, body mass index, and subsequent kidney disease and death. Am J Kidney Dis. 2008;52(1):29-38. https://doi.org/10.1053/j.ajkd.2008.02.363 PMid:18511168 DOI: https://doi.org/10.1053/j.ajkd.2008.02.363

Laurinavicius AG, Santos RD. Dyslipidemia, statins and chronic renal failure. Rev Bras Hipertens 2008;15:156-61.

Ohkawa S, Odamaki M, Ikegaya N, Hibi I, Miyaji K, Kumagai H. Association of age with muscle mass, fat mass and fat distribution in non-diabetic haemodialysis patients. Nephrol Dial Transplant. 2005;20(5):945-51. https://doi.org/10.1093/ndt/gfh643 PMid:15769826 DOI: https://doi.org/10.1093/ndt/gfh643

World Health Organization. Diet, Nutrition and Prevention of Chronic Diseases. Report of a Joint WHO/FAO Expert Consultation. Geneva: World Health Organization; 2003.

Matsudo SM, Matsudo VK, Neto TL. Impact of aging on anthropometric, neuromotor and metabolic variables of physical fitness. Rev Bras Ciên (RBCM). Rev Bras Ciên. 2000;8:21-32.

Ekart R; Hojs R. Obese and diabetic patients with end-stage renal disease: Peritoneal dialysis or hemodialysis? Eur J Intern Med. 2016;32:1-6. https://doi.org/10.1016/j.ejim.2016.03.016 PMid:27067614 DOI: https://doi.org/10.1016/j.ejim.2016.03.016

Zaman SB, Hossain N, Rahman M. Associations between Body Mass Index and chronic kidney disease in Type 2 diabetes mellitus patients: Findings from the Northeast of Thailand. Diabetes Metab J. 2018;42(4):330-7. https://doi.org/10.4093/dmj.2017.0052 PMid:30136452 DOI: https://doi.org/10.4093/dmj.2017.0052

Bae JP, Lage MJ, Mo D, Nelson DR, Hoogwerf BJ. Obesity and glycemic control in patients with diabetes mellitus: Analysis of physician electronic health records in the US from 2009-2011. J Diabetes Complications. 2016;30(2):212-20. https://doi.org/10.1016/j.jdiacomp.2015.11.016 PMid:26689451 DOI: https://doi.org/10.1016/j.jdiacomp.2015.11.016

Kalantar-Zadeh K, Block G, Humphreys MH, Kopple JD. Reverse epidemiology of cardiovascular risk factors in maintenance dialysis patients. Kidney Int 2003;63(3):793-808. https://doi.org/10.1046/j.1523-1755.2003.00803.x PMid:12631061 DOI: https://doi.org/10.1046/j.1523-1755.2003.00803.x

Kopple JD, Zhu X, Lew NL, Lowrie EG. Body weight-for-height relationships predict mortality in maintenance hemodialysis patients. Kidney Int. 1999;56(3):1136-48. https://doi.org/10.1046/j.1523-1755.1999.00615.x PMid:10469384 DOI: https://doi.org/10.1046/j.1523-1755.1999.00615.x

Lowrie EG, Lew NL. Death risk in hemodialysis patients: The predictive value of commonly measured variables and an evaluation of death rate differences between facilities. Am J Kidney Dis. 1990;15(5):458-82. https://doi.org/10.1016/s0272-6386(12)70364-5 PMid:2333868 DOI: https://doi.org/10.1016/S0272-6386(12)70364-5

Coresh J, Longenecker JC, Miller ER 3rd, Young HJ, Klag MJ. Epidemiology of cardiovascular risk factors in chronic renal disease. J Am Soc Nephrol. 1998;9(1):S24-30. PMid:11443765

Kalantar-Zadeh K, Kopple JD. Relative contributions of nutrition and inflammation to clinical outcome in dialysis patients. Am J Kidney Dis. 2001;38(6):1343-50. https://doi.org/10.1053/ajkd.2001.29250 PMid:11728973 DOI: https://doi.org/10.1053/ajkd.2001.29250

Fleischmann EH, Bower JD, Salahudeen AK. Risk factor paradox in hemodialysis: Better nutrition as a partial explanation. ASAIO J. 2001;47(1):74-81. https://doi.org/10.1097/00002480-200101000-00016 PMid:11199320 DOI: https://doi.org/10.1097/00002480-200101000-00016

Nishizawa Y, Shoji T, Ishimura E, Inaba M, Morii H. Paradox of risk factors for cardiovascular mortality in uremia: Is a higher cholesterol level better for atherosclerosis in uremia? Am J Kidney Dis. 2001;38(1):S4-7. https://doi.org/10.1053/ajkd.2001.27380 PMid:11576913 DOI: https://doi.org/10.1053/ajkd.2001.27380

Ritz E, Nowicki M, Wiecek A. Excess cardiovascular mortality in the uremic patient What does it teach for other risk factors in the non-renal patient? Pol Arch Med Wewn. 1994;92(Spec No):110-6. PMid:7731891

Mohammedi K, Chalmers J, Herrington W, Li Q, Mancia G, Marre M, et al. Associations between body mass index and the risk of renal events in patients with Type 2 diabetes. Nutr Diabetes. 2018;8(7):7. https://doi.org/10.1038/s41387-017-0012-y PMid:29343817 DOI: https://doi.org/10.1038/s41387-017-0012-y

Downloads

Published

2022-01-03

How to Cite

1.
Elezi B, Topi S, Abazaj E. Profile of Obesity and Comorbidities and their Correlation among Hemodialysis Patients, Elbasan. Open Access Maced J Med Sci [Internet]. 2022 Jan. 3 [cited 2024 Jul. 23];10(E):225-32. Available from: https://oamjms.eu/index.php/mjms/article/view/7519

Issue

Section

Public Health Epidemiology

Categories

Most read articles by the same author(s)