The Role of Obesity in Kidney Transplantation Outcome

Grosso, Giuseppe; Corona, Daniela; Mistretta, Antonio; Zerbo, D.; Sinagra, N.; Giaquinta, Alessia; Caglià, Pietro; Amodeo, C; Leonardi, Alessandra; Gula, R.; Veroux, Massimiliano

doi:10.1016/j.transproceed.2012.06.043

Cited by 54 publications

(48 citation statements)

References 31 publications

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“…64 In a retrospective study of 376 Italian kidney transplant recipients, obesity was an independent risk factor for graft loss and patient death. 65 In another retrospective single center study of 1132 deceased donor kidney grafts, multivariate analysis revealed recipient BMI and dialysis vintage as independent risk factors for delayed graft function. 66 Molnar et al 67 reported that pretransplant overweight or obesity is associated with an incrementally higher risk of delayed graft function.…”

Section: Obesity and Kidney Transplantationmentioning

confidence: 99%

Obesity in CKD—What Should Nephrologists Know?

Stenvinkel

Zoccali

İkizler

2013

Journal of the American Society of Nephrology

196

172

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Obesity, the epidemic of the 21st century, carries a markedly increased risk for comorbid complications, such as type 2 diabetes, cancer, hypertension, dyslipidemia, cardiovascular disease, and sleep apnea. In addition, obesity increases the risk for CKD and its progression to ESRD. Paradoxically, even morbid obesity associates with better outcomes in studies of ESRD patients on maintenance dialysis. Because the number of obese CKD and maintenance dialysis patients is projected to increase markedly in developed as well as low-and middle-income countries, obesity is a rapidly emerging problem for the international renal community. Targeting the obesity epidemic represents an unprecedented opportunity for health officials to ameliorate the current worldwide increase in CKD prevalence. Nephrologists need more information about assessing and managing obesity in the setting of CKD. Specifically, more precise estimation of regional fat distribution and the amount of muscle mass should be introduced into regular clinical practice to complement more commonly used practical markers, such as body mass index. Studies examining the effects of obesity on kidney disease progression and other clinical outcomes along with weight management strategies are much needed in this orphan area of research. 24: 172724: -173624: , 201324: . doi: 10.1681 Obesity has emerged as the largest pandemic in near history, with important implications of not only cardiovascular disease (CVD) but also CKD. Recent data from the United States indicate that the incidence and prevalence rates of obesity in maintenance dialysis patients largely exceed the corresponding figures in the general population. 1 A large European population survey documented that a high body mass index (BMI) ranks as one of the strongest risk factors for new-onset CKD. 2 The dimension of the obesity epidemic and the impact of the same epidemic on the kidney demand efforts for understanding the epidemiology and the mechanisms of CKD associated with excess adiposity. It also sets as an absolute public health priority for the development of treatment policies integrated across specialties and general practice to halt this much concerning problem. In this scenario, it is fundamental that nephrologists are updated on current knowledge about obesity in the setting of CKD. However, little attention is still paid to this issue in major nephrology journals. The suboptimal attention to the problem by major sources of dissemination of specialty information suggests that nephrologists may have scarce knowledge of how obesity should be assessed, its epidemiology, mechanisms whereby excess fat mass is conducive to CKD, and management of obesity in the catabolic uremic milieu. 3 J Am Soc Nephrol DEFINITION AND ASSESSMENT OF OBESITYThe most common method for defining obesity is based on BMI (i.e., a person's weight as obese. It should be emphasized that population norms of BMI could be different based on ethnic and racial background (i.e., the proportion of Asian people with a high ...

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Section: Obesity and Kidney Transplantationmentioning

confidence: 99%

Obesity in CKD—What Should Nephrologists Know?

Stenvinkel

Zoccali

İkizler

2013

Journal of the American Society of Nephrology

196

172

View full text Add to dashboard Cite

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“…45 In comparison with healthy renal transplant recipients (BMI of 18.5-24.9 kg/m 2 ), obese renal transplant recipients had an HR of developing type 2 diabetes mellitus of 1.01 (95% CI, 0.98-1.07). 22,25,31,37,41 These results indicate essentially no statistically significant difference in the risks of developing type 2 diabetes mellitus between healthy transplant recipients and obese transplant recipients (heterogeneity, 74%; P < .01).…”

Section: Allograft Lossmentioning

confidence: 89%

“…21,23,[30][31][32][33][34][35][36][37][38][39][40] The 13 studies assessed 48 719 patients. Allograft loss was defined in accordance with the journal Kidney International as "either the need to re-transplant, resume chronic hemodialysis, or undergo a nephrectomy.…”

Section: Allograft Lossmentioning

confidence: 99%

“…43 The HR for allograft loss in obese recipients was 1.54 (95% CI, 1.38-1.68). 21,23,[30][31][32][33][34][35][36][37][38][39][40] This HR represents statistically significant evidence of greater allograft loss in obese transplant recipients (heterogeneity, I 2 = 3%; P = .49). 45 In comparison with healthy renal transplant recipients (BMI of 18.5-24.9 kg/m 2 ), obese renal transplant recipients had an HR of developing type 2 diabetes mellitus of 1.01 (95% CI, 0.98-1.07).…”

Section: Allograft Lossmentioning

confidence: 99%

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2016

Exp Clin Transplant

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Objectives: The prevalence of obesity is increasing rapidly and globally, yet systemic reviews on this topic are scarce. Our meta-analysis and systemic review aimed to assess how obesity affects 5 postoperative outcomes: biopsy-proven acute rejection, patient death, allograft loss, type 2 diabetes mellitus after transplant, and delayed graft function. Materials and Methods: We evaluated peer-reviewed literature from 22 medical databases. Studies were included if they were conducted in accordance with the Meta-analysis of Observational Studies in Epidemiology criteria, only examined postoperative outcomes in adult patients, only examined the relation between recipient obesity at time of transplant and our 5 postoperative outcomes, and had a minimum score of > 5 stars on the Newcastle-Ottawa scale for nonrandomized studies. Reliable conclusions were ensured by having our studies examined against 2 internationally known scoring systems. Obesity was defined in accordance with the World Health Organization as having a body mass index of > 30 kg/m 2 . All obese recipients were compared versus "healthy" recipients (body mass index of 18.5-24.9 kg/m 2 ). Hazard ratios were calculated for biopsy-proven acute rejection, patient death, allograft loss, and type 2 diabetes mellitus after transplant. An odds ratio was calculated for delayed graft function. Results: We assessed 21 retrospective observational studies in our meta-analysis (N = 241 381 patients). In obese transplant recipients, hazard ratios were 1.51 (95% confidence interval, 1.24-1.78) for presence of biopsy-proven acute rejection, 1.19 (95% confidence interval, 1.10-1.31) for patient death, 1.54 (95% confidence interval, 1.38-1.68) for allograft loss, and 1.01 (95% confidence interval, 0.98-1.07) for development of type 2 diabetes mellitus. The odds ratio for delayed graft function was 1.81 (95% confidence interval, 1.51-2.13). Conclusions: Our meta-analysis clearly demonstrated greater risks for obese renal transplant recipients and poorer postoperative outcomes with obesity. We confidently recommend renal transplant candidates seek medically supervised weight loss before transplant.

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“…Em 2011, a Organização Mundial de Saúde (OMS) estimou que 1,46 bilhão de indivíduos estavam com sobrepeso e desses 500 milhões com obesidade 23 . Entre pacientes com transplante renal efetivado, os valores também são elevados, já que em estudo com 376 receptores, aproximadamente 17% estava obeso, conforme descrito por Grosso e colaboradores 24 . Na população geral brasileira, de acordo com o VIGITEL de 2014 25 , o qual avalia fatores de risco e proteção na população das capitais brasileiras, 52,5% dos brasileiros estavam acima do peso enquanto 17,9% apresentam obesidade.…”

Section: Discussionunclassified