DOSE BODY FAT MASS DEFINE SURVIVAL IN PATIENTS STARTING PERITONEAL DIALYSIS?

Peritoneal dialysis (PD) is characterized by a gain in fat mass. In contrast to subcutaneous fat, visceral fat is associated with metabolic syndrome and survival. We prospectively examined whether the visceral or subcutaneous fat could define outcomes in patients undergoing PD. We studied 105 new patients (51 males) undergoing PD between February 2006 and April 2011. Baseline body composition was measured by computed tomogram. Visceral and subcutaneous obesity are defined as a visceral fat area >°100cm2 and subcutaneous fat area >°130°cm2, respectively. Thirty-three and 25 patients were diagnosed with visceral and subcutaneous obesity, respectively. Nineteen patients had both visceral and subcutaneous obesity. The 1-year and 5-year survival rates were 91% and 75%, respectively. The peritonitis and exit infection rates were 0.36 and 0.13/patient-year, respectively. Patients with visceral obesity had poor outcomes compared with those without visceral obesity (p=0.025). Subcutaneous obesity was not associated with peritonitis or survival. A multivariate Cox regression analysis did not show that visceral obesity was a risk factor of poor outcome. Increased visceral fat at the initiation of PD is not an independent predictor of poor outcome. The impact of visceral or subcutaneous mass for outcomes in patients undergoing PD would be better defined by large and long term studies