Abdominal Obesity in Hemodialysis: High-Risk Inflammatory Phenotype in Patients with Diabetes

Background: Patients with type 2 diabetes (T2D) on hemodialysis (HD) are at increased cardiovascular risk, where body composition and inflammation could be key modulating factors. The waist-to-height ratio (WtHR) has been proposed as a simple and effective marker of central adiposity, but its role in this population remains underexplored. AIM: To evaluate differences in body composition (BC), inflammatory and nutritional parameters between T2D and non-T2D patients on HD, and to analyze the impact of the central obesity phenotype defined by WtHR ≥0.5. Methods: Prospective, multicenter study with 455 prevalent HD patients. Demographic, clinical, nutritional, BC, and inflammatory variables were collected: neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and systemic inflammatory index (SII). Post-dialysis multifrequency bioimpedance (MF-BIA) was used to assess phase angle (PhA), extracellular water/total body water ratio (ECW/TBW-r), total body fat (PBF), and visceral fat (VFA). Abdominal obesity was defined as WtHR ≥0.5. Non-parametric tests and Chi-square tests were applied; statistical significance: p<0.05. Results: T2D patients were older [73 vs. 69 years, p=0.007], had a higher BMI [26.1 vs. 23.8 kg/m2, p<0.001], PBF [30.7% vs. 25.2%, p<0.001], VFA 96.5 vs. 71.3 cm3, p<0.001, higher SII and INL (p=0.001 and p=0.008), higher proportion with INL≥3.5 (p=0.004), lower PhA [4.7° vs. 5.1°, p<0.001, and higher ECW/TBW-r (p<0.001). Fifty-six percent of T2D patients had WtHR ≥0.5. Among T2D patients, those with WtHR ≥0.5 had higher levels of VFA, IBS, INL (p<0.05), lower PhA, and higher ECW/TBW-r. In addition, they required catheters as vascular access more frequently (CYT: 64.2% vs. 35.8%, p=0.02). In the subgroup with WtHR <0.5, T2D patients continued to have older age, higher VFA, lower PhA, and higher ECW/TBW-r than non-T2D patients, with no differences in inflammation or PBF. Conclusion: The T2D phenotype with WtHR ≥0.5 in HD is associated with greater visceral adiposity, systemic inflammation, and cellular nutritional impairment, which could reflect an increased cardiovascular risk profile. The use of WtHR as a simple tool in clinical practice may contribute to more accurate risk stratification in this vulnerable population.