Peritoneal dialysis in patients with severe obesity: A successful single center experience

There is growing emphasis on increasing utilization of peritoneal dialysis (PD) in patients with end stage kidney disease (ESKD); however, use in patients with severe obesity has still been fraught for various reasons. We aim to assess the viability of PD in patients with severe obesity (BMI > 40 Kg/m²). We conducted a retrospective chart review of patients admitted at the home dialysis center of an academic center between 2014 and 2020 (n = 99). Patients with a BMI>40 kg/m² at the time of PD initiation (n = 9) were selected. We extracted and examined the data for these nine patients till March 2023. The mean age at baseline was 47.8 ± 12.6 year, 56% were males, 67% were Hispanic, 33% were white, and mean BMI was 43.3 ± 3.4 kg/m². By the end of the follow-up of this report, five (56%) patients were still active on PD (mean duration 27.8 ± 4.5 months). PD therapy was terminated in 3 (33%) patients (17.7 ± 6.8 months) due to refractory peritonitis, burnout, transfer to rehabilitation facility, respectively. One patient transferred out to another facility after 10.6 months. Rates of access and mechanical complications as well as peritonitis in these nine patients were similar to center's overall rates. All the patients had elimination of uremic symptoms using incremental prescription and met weekly Kt/V targets of >1.7 using adjusted weight. Overall, patients’ weight and glycemic control remained stable. In conclusion, PD can be an effective long-term high-quality dialysis option for patients with ESKD and severe obesity. Further studies in a larger population are required to confirm our findings.