Visceral Adiposity and not only Total Body Fat Content Should Be Viewed as a Critical Parameters in health Prognosis in Renal Failure

Recently Molnar and Kalantar-Zadeh published a thought-provoking review article discussing the “obesity paradox” and its link to survival in dialysis patients and renal transplant recipients (1). The authors carefully examined the literature reporting on the reverse epidemiology of obesity in dialysis patients as well as the literature on the association between pre-transplant obesity and post-transplant outcome. The authors concluded that a higher BMI score appears to provide an advantage in dialysis patients’ survival while the data for the renal transplant patients are still unclear. They also convincingly argued that the BMI as a sole index of obesity does not represent a true body composition status, something critical for a patient since this index ignores significant parameters that affect survival such as total lean body mass and fat content. They concluded that further research is need to “better understand the association between obesity, muscle mass and body composition”.