Hypertension and nephrology

[Association of body composition and mortality in patients on maintenance dialysis and on waitlist and after kidney transplantation]

UJSZÁSZI Ákos1, KALANTAR-ZADEH Kamyar2,3, MOLNÁR Miklós Zsolt1,2,4

DECEMBER 20, 2011

Hypertension and nephrology - 2011;15(05)

[Overweight [body mass index (BMI) = 25-30 kg/m2] and obesity (BMI ≥30 kg/m2) are epidemic in both developed and developing countries. Obesity has been recognized as risk factor for the development and progression of chronic kidney disease and is associated with increased cardiovascular risk and poor survival. Almost 2/3 of maintenance hemodialysis patients die within five years of commencing dialysis treatment. Although patients on the waitlist having less severe comorbidities than their non-listed counterparts, the death rate remains high while it can take years for an organ donation. In patients with end stage renal disease (ESRD) undergoing maintenance hemodialysis an “obesity paradox” has been consistently reported, i.e., a high BMI is incrementally associated with better survival. Overweight and obesity are highly prevalent in patients at the time of kidney transplantation. Indeed, most transplant centers in US may suspend wait-listing of obese patients with a BMI above 30 or 35 kg/m2 and refer them for weight reduction procedures such as bariatric surgery as a contingency for the transplant surgery. The effect of pre- and post-transplant obesity in kidney transplanted patients on long-term graft and patient survival has not been well established. We have reviewed and summarized salient recent data pertaining to body composition and clinical outcomes about the association of survival and body composition in transplant-waitlisted dialysis patients and kidney transplanted recipients. ]

AFFILIATIONS

  1. Semmelweis Egyetem, Kórélettani Intézet, Budapest
  2. Harold Simmons Center for Chronic Disease Research & Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, Egyesült Államok
  3. David Geffen School of Medicine at UCLA, Los Angeles, CA, Egyesült Államok
  4. Semmelweis Egyetem, Magatartástudományi Intézet, Budapest

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