Obesity and Body Composition for Transplant Wait-List Candidacy—Challenging or Maintaining the BMI Limits?

Johansen, Kirsten L.

doi:10.1053/j.jrn.2013.02.005

Cited by 28 publications

(22 citation statements)

References 14 publications

(23 reference statements)

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“…Furthermore, the risk of surgical and post-surgical problems is increased, including retarded wound healing and infection, lymphocele, new onset diabetes after transplant, and cardiovascular disease [ 23 , 24 ]. The issue is important to the point that even if formal contraindications are seldom posed in the current guidelines, some transplant centres systematically choose not to wait-list obese patients [ 25 , 26 , 27 , 28 , 29 , 30 , 31 ].…”

Section: Introductionmentioning

confidence: 99%

Weight Loss in Advanced Chronic Kidney Disease: Should We Consider Individualised, Qualitative, ad Libitum Diets? A Narrative Review and Case Study

Capizzi

Teta²,

Vigotti

et al. 2017

Nutrients

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In advanced chronic kidney disease, obesity may bring a survival advantage, but many transplant centres demand weight loss before wait-listing for kidney graft. The case here described regards a 71-year-old man, with obesity-related glomerulopathy; referral data were: weight 110 kg, Body Mass Index (BMI) 37 kg/m2, serum creatinine (sCr) 5 mg/dL, estimated glomerular filtration rate (eGFR) 23 mL/min, blood urea nitrogen (BUN) 75 mg/dL, proteinuria 2.3 g/day. A moderately restricted, low-protein diet allowed reduction in BUN (45–55 mg/dL) and good metabolic and kidney function stability, with a weight increase of 6 kg. Therefore, he asked to be enrolled in a weight-loss program to be wait-listed (the two nearest transplant centres required a BMI below 30 or 35 kg/m2). Since previous low-calorie diets were not successful and he was against a surgical approach, we chose a qualitative, ad libitum coach-assisted diet, freely available in our unit. In the first phase, the diet is dissociated; he lost 16 kg in 2 months, without need for dialysis. In the second maintenance phase, in which foods are progressively combined, he lost 4 kg in 5 months, allowing wait-listing. Dialysis started one year later, and was followed by weight gain of about 5 kg. He resumed the maintenance diet, and his current body weight, 35 months after the start of the diet, is 94 kg, with a BMI of 31.7 kg/m2, without clinical or biochemical signs of malnutrition. This case suggests that our patients can benefit from the same options available to non-CKD (chronic kidney disease) individuals, provided that strict multidisciplinary surveillance is assured.

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Section: Introductionmentioning

confidence: 99%

Weight Loss in Advanced Chronic Kidney Disease: Should We Consider Individualised, Qualitative, ad Libitum Diets? A Narrative Review and Case Study

Capizzi

Teta²,

Vigotti

et al. 2017

Nutrients

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“…The mean BMI and prevalence of obesity among incident dialysis patients have been increasing steadily over the last 15 years (Figs 1 and 2) [9,10]. In 2002, almost one-third of all adult incident dialysis patients were obese [9], and by 2009 the mean BMI was almost in the obese range at over 29 kg/m 2 [10].…”

Section: Introductionmentioning

confidence: 99%

“…In 2002, almost one-third of all adult incident dialysis patients were obese [9], and by 2009 the mean BMI was almost in the obese range at over 29 kg/m 2 [10]. However, new evidence suggests that even these staggering numbers may underestimate the prevalence of obesity in the ESRD population.…”

Section: Introductionmentioning

confidence: 99%

Body composition in chronic kidney disease

Johansen¹,

Lee²

2015

Current Opinion in Nephrology and Hypertension

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Purpose of review To summarize the latest information on body composition among patients with chronic kidney disease and its association with outcomes. Recent findings Obesity is increasing among patients with end-stage renal disease and is more prevalent when direct measures of adiposity are used rather than BMI. High BMI is not associated with better survival among patients with earlier chronic kidney disease or after kidney transplantation, suggesting that excess fat is most protective among the sickest patients. Despite the positive association between BMI and survival among patients with end-stage renal disease, visceral fat is associated with coronary artery calcification and adverse cardiovascular events. Muscle wasting is prominent among patients with chronic kidney disease, sometimes even in the setting of obesity. Obesity and muscle wasting are associated with worse physical functioning. Indicators of low muscle size and strength are associated with higher mortality. Some interventions can affect body composition, but whether they affect survival has not been determined. Summary Recent studies show that a high BMI is not protective for all patients with chronic kidney disease and is associated with poor physical functioning and frailty. Visceral adiposity is associated with adverse cardiovascular outcomes. Sarcopenia is common among patients with end-stage renal disease and is associated with worse physical performance and higher mortality.

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“…Of note, these reports reveal epidemiological associations but do not prove causation nor do they differentiate between intentional and unintentional weight loss. On the other hand, the presence of obesity lowers the likelihood of being waitlisted for kidney transplantation (6,7). Intentional weight loss also offers the potential of improving quality of life and/or ameliorating illnesses as in the general populace, though studies demonstrating this are thus far lacking.…”

Section: Introductionmentioning

confidence: 99%

Personal Attitudes Toward Weight in Overweight and Obese US Hemodialysis Patients

Saeed

Janda

Tucker

et al. 2017

Journal of Renal Nutrition

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Obesity and Body Composition for Transplant Wait-List Candidacy—Challenging or Maintaining the BMI Limits?

Cited by 28 publications

References 14 publications

Weight Loss in Advanced Chronic Kidney Disease: Should We Consider Individualised, Qualitative, ad Libitum Diets? A Narrative Review and Case Study

Weight Loss in Advanced Chronic Kidney Disease: Should We Consider Individualised, Qualitative, ad Libitum Diets? A Narrative Review and Case Study

Body composition in chronic kidney disease

Personal Attitudes Toward Weight in Overweight and Obese US Hemodialysis Patients

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