Management of peritoneal dialysis in patients with obesity

PURPOSE OF REVIEW: The healthcare system is increasingly burdened by the rising number of patients with end-stage kidney disease (ESKD), alongside a parallel surge in obesity. However, use of peritoneal dialysis in patients with obesity has been met with caution despite increasing recognition of advantages of home dialysis. This review addresses these concerns and outlines evidence-based guidelines for effective management. RECENT FINDINGS: Contemporary analysis of peritoneal dialysis cohorts demonstrates that catheter-related complications are not higher in patients with obesity compared to normal weight using basic or advanced laparoscopic methods, and even percutaneously placed catheters can achieve good outcomes using technical advancements. A meticulously identified and well placed exit site facilitates infection free peritoneal dialysis delivery in patients with obesity. It is important to recognize that adipocytes have a significantly lower water content; therefore, adjusted body weight is proposed to estimate the volume of distribution and the clearance of small solutes more accurately. The practice of incremental dialysis and use of Icodextrin for long dwells help limit glucose exposure and manage related metabolic complications. Recent evidence does not support the notion that peritoneal dialysis modality alters the impact of obesity on likelihood of transplantation or overall survival. SUMMARY: Obesity is associated with adverse outcomes in dialysis patients; however, these effects are comparable between hemodialysis and peritoneal dialysis, and are not more pronounced in peritoneal dialysis. With careful technical and clinical considerations, peritoneal dialysis therapy can be effectively delivered to patients with obesity without imposing undue burden. Therefore, obesity should not be viewed as a contraindication to peritoneal dialysis.