Ng Jack Kit-Chung, Than Win Hlaing, Szeto Cheuk Chun
Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
Li Ka Shing Institute of Health Sciences (LiHS), Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
Front Nephrol. 2022 Jun 28;2:880097. doi: 10.3389/fneph.2022.880097. eCollection 2022.
Obesity is a global epidemic that has a complicated pathogenesis as well as impact on the outcome of peritoneal dialysis (PD) patients. In this review, the prevalence of obesity in incident PD patients as well as the phenomenon of new-onset glucose intolerance after PD will be reviewed. Published literature on the effect of obesity on the survival and incidence of cardiovascular disease in PD patients will be discussed. Particular emphasis would be put on literature that compared the impact of obesity on the outcome of hemodialysis and PD, and the confounding effect of dialysis adequacy. Next, the complex concept of obesity and its relevance for PD will be explored. The focus would be put on the methods of assessment and clinical relevance of central versus general obesity, as well as visceral versus subcutaneous adipose tissue. The relation between obesity and systemic inflammation, as well as the biological role of several selected adipokines will be reviewed. The confounding effects of metabolic syndrome and insulin resistance will be discussed, followed by the prevalence and prognostic impact of weight gain during the first few years of PD. The differences between weight gain due to fluid overload and accumulation of adipose tissue will be discussed, followed by the current literature on the change in body composition after patients are put on chronic PD. The methods of body composition will be reviewed, and the clinical relevance of individual body component (fluid, fat, muscle, and bone) will be discussed. The review will conclude by highlighting current gaps of knowledge and further research directions in this area.
肥胖是一种全球性的流行病，其发病机制复杂，且对腹膜透析（PD）患者的预后有影响。在这篇综述中，将回顾新发PD患者的肥胖患病率以及PD后新发葡萄糖不耐受的现象。将讨论已发表的关于肥胖对PD患者生存和心血管疾病发病率影响的文献。将特别强调比较肥胖对血液透析和PD预后影响以及透析充分性混杂效应的文献。接下来，将探讨肥胖这一复杂概念及其与PD的相关性。重点将放在中心性肥胖与全身性肥胖以及内脏脂肪组织与皮下脂肪组织的评估方法和临床相关性上。将回顾肥胖与全身炎症的关系以及几种选定脂肪因子的生物学作用。将讨论代谢综合征和胰岛素抵抗的混杂效应，随后是PD最初几年体重增加的患病率和预后影响。将讨论因液体超负荷导致的体重增加与脂肪组织堆积之间的差异，随后是关于患者开始慢性PD后身体成分变化的现有文献。将回顾身体成分的评估方法，并讨论各个身体成分（液体、脂肪、肌肉和骨骼）的临床相关性。综述将通过突出该领域当前的知识空白和进一步的研究方向来结束。
