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NDT Advance Access originally published online on March 17, 2006
Nephrology Dialysis Transplantation 2006 21(6):1729; doi:10.1093/ndt/gfl100
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

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Email: knark{at}amg.gda.pl

Sir,

I appreciate Dr Salahudeen's interest in my editorial. He raises several insightful points regarding the complex interaction between obesity, hypertension and chronic renal failure. He is correct in pointing out that the causal nature of the relationship between obesity and better survival on haemodialysis has not been established. Indeed, this relationship might be confounded by several factors such as the effects of nutritional status, caloric intake, weight loss, neurohumoral activation, inflammation, co-existing diseases (including congestive heart failure) and drug therapy. These confounders may also affect the relationship between obesity and hypertension in end-stage renal failure. As suggested by Salahudeen et al. [1] in one of their earlier studies, weight loss and malnutrition through pro-inflammatory and anti-endothelial mechanisms may contribute to more severe hypertension in lean patients on haemodialysis. Therefore, the paradigm of a positive relationship between obesity and blood pressure holds true in normal humans, but it cannot be extrapolated to include such pathological conditions as end-stage renal failure. There is a clear need for further prospective studies analysing the contribution of weight change, nutritional status and neurohumoral abnormalities to hypertension and to survival in patients with renal failure. This may be of potential relevance to devising future treatment strategies for chronic renal failure and its cardiovascular consequences.

Krzysztof Narkiewicz

Department of Hypertension and Diabetology Medical University of Gdañsk Gdañsk, Poland

References

  1. Salahudeen AK, Fleischmann EH, Bower JD, Hall JE. Underweight rather than overweight is associated with higher prevalence of hypertension: BP vs BMI in haemodialysis population. Nephrol Dial Transplant 2004; 19: 427–432[Abstract/Free Full Text]

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This Article
Right arrow Extract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
21/6/1729-a    most recent
gfl100v1
Right arrow Alert me when this article is cited
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Right arrow Articles by Narkiewicz, K.
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Right arrow Articles by Narkiewicz, K.
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