Obesity paradox in patients on maintenance dialysis.

摘要: Overweight (body mass index [BMI]=25-30 kg/m2) and obesity (BMI>30 have become phenomena with a pronounced upward trend in prevalence most countries throughout the world are associated increased cardiovascular risk poor survival. In patients chronic kidney disease (CKD) undergoing maintenance hemodialysis an 'obesity paradox' has been consistently reported, i.e., high BMI is incrementally better While this 'reverse epidemiology' of relatively consistent patients, studies peritoneal dialysis yielded mixed results. A similar paradox described heart failure as well 20 million members other distinct medically 'at risk' populations USA. Possible causes reverse epidemiology include: (1) time-discrepancies between competing risks for adverse events that overnutrition undernutrition; (2) sequestration uremic toxins adipose tissue; (3) selection gene pool favorable to longer survival during course CKD progression, which eliminates over 95% population before they commence therapy; (4) more stable hemodynamic status; (5) alterations circulating cytokines; (6) unique neurohormonal constellations; (7) endotoxin-lipoprotein interactions; (8) causation. Examining consequences can improve our understanding paradoxes observed both conventional factors such blood pressure serum cholesterol, populations, failure, cancer or AIDS geriatric populations.