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. 2025 Aug;57(8):2595-2601.
doi: 10.1007/s11255-025-04438-w. Epub 2025 Feb 28.

Impact of obesity on in-hospital outcomes in peritoneal dialysis patients: insights from a nationwide analysis

Wisit Kaewput  1 , Charat Thongprayoon  2 , Supawadee Suppadungsuk  3   4 , Supawit Tangpanithandee  3 , Wannasit Wathanavasin  3   5 , Fawad Qureshi  3 , Wisit Cheungpasitporn  3
Affiliations

Impact of obesity on in-hospital outcomes in peritoneal dialysis patients: insights from a nationwide analysis

Wisit Kaewput et al. Int Urol Nephrol. 2025 Aug.

Abstract

Background: Obesity is a growing public health concern and may influence outcomes in end-stage kidney disease (ESKD) patients undergoing peritoneal dialysis (PD). However, its impact on in-hospital complications, mortality, and healthcare utilization in this population remains unclear. This study aimed to assess the association between obesity and hospitalization-related outcomes in PD patients.

Methods: This study was conducted using the National Inpatient Sample to identify hospitalized ESKD patients receiving PD from the year 2003 to 2018. The in-hospital treatments, outcomes, and resource utilization were compared between obese and non-obese patients, adjusting for age, sex, race, year of hospitalization, and comorbidities.

Results: A total of 100,523 hospitalized ESKD patients receiving PD were included in the analysis. Of these, 9890 (9.8%) had obesity diagnosis. In the adjusted analysis, obese patients had a higher need for procedures for PD catheter adjustment or removal (OR 1.29; 95% CI 1.16-1.43), hemodialysis (OR 1.28; 95% CI 1.19-1.38), and mechanical ventilation (OR 1.29; 95% CI 1.16-1.44), compared to non-obese patients. Obesity was significantly associated with higher risk of PD peritonitis (OR 1.12; 95% CI 1.06-1.19) and fluid overload (OR 1.34; 95% CI 1.23-1.45) but lower in-hospital mortality (OR 0.84; 95% CI 0.73-0.96). There was no significant difference in length of hospital stay and hospitalization cost between obese and non-obese patients.

Conclusion: Among hospitalized PD patients, obesity is associated with higher PD-related complications and increased need for interventions but is paradoxically linked to lower in-hospital mortality. These findings provide new insights into the obesity paradox in PD and highlight the need for tailored management strategies to mitigate obesity-related risks in hospitalized PD patients.

Keywords: Hospitalization; Mortality; Obesity; PD-related complications; Peritoneal dialysis; Resource utilization.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare no competing interests.

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