Metabolic Phenotype-Stratified Associations Between Obesity/Overweight and Mortality in Peritoneal Dialysis Patients.

BACKGROUND: Metabolic abnormalities and obesity/overweight are prevalent in peritoneal dialysis (PD) patients, and their interplay may significantly impact clinical outcomes. This study aimed to investigate the association between metabolic phenotypes (stratified by body mass index [BMI] and metabolic status) and all-cause mortality in PD patients. METHODS: This multicenter cohort study was conducted from January 1, 2001, to May 31, 2023. Participants were categorized into four metabolic phenotypes based on their BMI and metabolic status: Metabolically Healthy Overweight/Obesity (MHO), Metabolically Healthy Non-Overweight/Obesity (MHNO), Metabolically Unhealthy Overweight/Obesity (MUO), Metabolically Unhealthy Non-Overweight/Obesity (MUNO). The primary outcome is all-cause mortality. Cox regression analysis was employed to evaluate the association between metabolic phenotypes and all-cause mortality. RESULTS: The study cohort comprised 4305 participants, with 1034 deaths during follow-up. Compared with the MHNO subgroup patients, those in the MUNO subgroup (HR, 1.169; 95%CI, 1.007-1.356) and the MUO subgroup (HR, 1.206; 95% CI, 1.013-1.437) exhibited a higher risk of all-cause mortality, whereas patients in the MHO group did not show an increased risk (HR, 0.921; 95% CI, 0.718-1.181). These results were consistent in subgroup and sensitivity analyses. CONCLUSION: In this cohort study, we found that patients with metabolic abnormalities showed a higher risk of all-cause mortality. The influence of BMI on all-cause mortality in PD patients varies with metabolic status; thus, metabolic status should be prioritized in risk stratification and personalized management for PD patients with overweight/obesity.