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Saudi Journal of Kidney Diseases and Transplantation
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ORIGINAL ARTICLE Table of Contents   
Year : 2009  |  Volume : 20  |  Issue : 3  |  Page : 375-377
Impact of obesity on development of chronic renal allograft dysfunction


1 Oxford, Transplant Center, The Churchill Hospital, Roosevelt Drive Headington, Oxford, United Kingdom; Nemazee Hospital Organ Transplantation Unit, Shiraz University of Medical Sciences, Shiraz, Iran
2 Oxford, Transplant Center, The Churchill Hospital, Roosevelt Drive Headington, Oxford, United Kingdom
3 Nemazee Hospital Organ Transplantation Unit, Shiraz University of Medical Sciences, Shiraz, United Kingdom

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   Abstract 

Obesity in nontransplant patients has been associated with hypertension, hyperlipi­demia, diabetes, and proteinuria. To determine whether renal transplant recipients with an elevated BMI have worse long term graft survival, we prospectively studied 92 patients transplanted between April 1999 and July 2000. Weight (Wt) and height of the patients were recorded prior to transplantation and two weeks, one, two and three years post transplantation. Blood urea nitrogen (BUN), creatinine (Cr) and blood pressure were checked monthly, while triglyceride, cholesterol, high den­sity lipoprotein (HDL), and low density lipoprotein (LDL) were obtained 3 monthly for 3 years post transplantation. Graft dysfunction was defined as serum Cr > 1.8 mg/dL. While BMI and Wt of the patients before transplantation did not show any significant correlation with chronic renal allograft dysfunction (CRAD), patients with higher Wt and BMI two weeks after transplantation showed an increased risk of developing CRAD during the three year post transplant independent of other risk factors (P< 0.05). Patients with greater Wt loss in the first two weeks post transplantation showed a decreased risk of developing CRAD in the following 3 years (P< 0.001). Our study suggests that high Wt and BMI are significantly associated with worse graft survival 3 years post renal trans­plantation.

Keywords: Renal transplantation, Chronic renal allograft dysfunction, Obesity, Body mass index, Outcome

How to cite this article:
Jahromi AH, Jalali GA, Roozbeh J. Impact of obesity on development of chronic renal allograft dysfunction. Saudi J Kidney Dis Transpl 2009;20:375-7

How to cite this URL:
Jahromi AH, Jalali GA, Roozbeh J. Impact of obesity on development of chronic renal allograft dysfunction. Saudi J Kidney Dis Transpl [serial online] 2009 [cited 2020 Nov 29];20:375-7. Available from: https://www.sjkdt.org/text.asp?2009/20/3/375/50759

   Introduction Top


Advancements in renal transplantation have dramatically improved outcome, especially one year graft survival rates for recipients with end­stage renal diseases (ESRD). [1] Increased body mass index (BMI) is an important risk factor for death in the general population, and has also been linked to cardiovascular death. [2] Some stu­ies found an association between decreased survival and increased BMI in renal transplant recipients, [3] however, other studies could not such association. [4],[5],[6] Obesity in non-transplant patients has been associated with hypertension, hyper-lipidemia, diabetes, proteinuria, and glomerulo­pathy. [7],[8]

We aim in this study to determine whether BMI is associated with decreased long term survival in renal transplant recipient.


   Patients and Methods Top


This prospective study included 92 patients (M=50, F=42) transplanted in our center between April 1999 and July 2000. Weight (Wt) and height of the patients were recorded prior to transplantation and two weeks, one, two and three years post transplantation. The dialysis duration before transplantation and medications were recorded. Blood urea nitrogen (BUN), se­rum creatinine (Cr) and blood pressure were checked monthly; triglyceride (TG), cholesterol, high density lipoprotein (HDL), and low density lipoprotein (LDL) 3-monthly for 3 years post transplantation. In this study, graft dysfunction was defined as serum Cr > 1.8 mg/dL, hyper­triglyceridemia as serum TG > 250 mg/dL, and hypercholesterolemia as serum cholesterol > 200 mg/dL. Hypertension was defined as BP > 140/90 on two occasions or being on antihyper­tensive medications.

Statistical Analysis

Results were analyzed by SPSS-10 software and for interpretation of results. Student "t" test, chi square, phi and Cramer test were used when indicated and P< 0.05 was defined as statisti­cally significant.


   Results Top


The mean age of recipients was 35.3 ± 9.8 years (range 16-58 years). Eleven patients re­ceived organs from deceased donors, 49 from living related donors (LRD), 12 from living un­related donors (LURD) and 20 from spouses. Demographic features of the study patients are shown in [Table 1].

The mean BMI of the patients was 21.4 ± 6.9 kg/m 2 (range 12.0-46.7 kg/m 2 ) and mean weight was 57.6 ± 15.2 kg (range 40.5-119.5 kg). The patients mean weight gain during 3 years time was 10.1 ± 7.4 kg (range 0-32 kg). BUN and creatinine of the patients prior to transplantation was 90 ± 29.8 mg/dL and 10.4 ± 4 mg/dL res­pectively. The patients were on dialysis for an average time of 4.7 ± 2.1 years before their transplantation. Development of renal allograft dysfunction did not show any association with the duration of dialysis (P= 0.21).

While BMI and Wt of the patients before transplantation did not show any significant correlation with chronic renal allograft dys­function (CRAD) (P> 0.05), patients with higher Wt and BMI two weeks after transplantation showed an increased risk of developing CRAD in the three year post transplant period inde­pendent of other risk factors checked (P< 0.05). The mean BMI two weeks post transplantation was significantly higher in patients showing CRAD in the 3 years post transplantation period than patients without CRAD (mean BMI 23.3 ± 6.0 vs. 20.0 ± 5.4 kg/m 2 , P< 0.05).

The mean Wt loss in the first 2 week post operation period was 0.6 ± 0.4 kg in patients with CRAD compared with 1.1 ± 0.7 kg in patients without CRAD in the three years post transplant period. Patients with greater Wt loss in the first two weeks after transplantation showed more decreased risk of developing CRAD in the three years post transplant period (P< 0.001).


   Discussion Top


Obesity continues to be a significant risk factor for morbidity and mortality in the general popu­lation. [9] Although obesity has been associated with improved survival on dialysis, the impact of obesity on graft survival after transplantation continues to be controversial. [3],[10],[11] Some studies have shown BMI to be a strong independent risk factor for graft failure independent of pa­tient's death after renal transplantation. 3 However, others reported no significant correlation bet­ween obesity and graft survival for either de­ceased or living donor transplants. [11] Better out­come of obese patients on dialysis could be ex­plained by more stable hemodynamic status, en­dotoxin lipoprotein interaction and protective effect of obesity on malnutrition in dialysis. [12],[13] We found BMI a strong independent risk factor for developing CRAD.

Previous studies have used pre transplant body weight for calculating BMI in the patients, which mainly might be affected by the amount of edema and inadequacy of the dialysis before transplantation. Our study results show that body weight 2 weeks post transplantation and when the transplanted kidney has started its function might be a better estimation of the dry weight of the patient and a better evaluation of the risk of allograft dysfunction.

Patients with greater Wt loss in the first two weeks post transplantation show a decreased risk of developing CRAD in the 3 year post trans­plantation. This might be due to a better func­tion of transplanted kidney in these patients during the first two weeks post transplantation. It seems that better function of the transplanted graft at this stage might be associated with lower risk of developing CRAD.

Our study suggests that high Wt and BMI are significantly associated with worse graft survival 3 years post renal transplantation.


   Acknowledgement Top


The authors would like to thank Ms. Samira Mazloom for her kind support in preparing the manuscript of this study.

 
   References Top

1.Mitsnefes MM, Khoury P, McEnery PT. Body mass index and allograft function in pediatric renal transplantation. Pediatr Nephrol 2002;17 (7):535-9.  Back to cited text no. 1    
2.Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath CW Jr. Body mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med 1999;341:1097-105.  Back to cited text no. 2    
3.Meier-Kriesche H, Arndorfer JA, Kaplan B. The impact of body mass index on renal transplant outcomes: A significant independent risk factor for graft failure and patient death. Transplantation 2002;73:70-4.  Back to cited text no. 3    
4.Hanevold CD, Ho PL, Talley L, Mitsnefes MM. Obesity and renal transplant outcome: A report of the North American Pediatric Renal Transplant Cooperative Study. Pediatrics 2005; 115:352-6.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Massarweh NN, Clayton JL, Mangum CA, Flor­man SS, Slakey DP. High body mass index and short and long term renal allograft survival in adults. Transplantation 2005;80:1430-4.  Back to cited text no. 5    
6.Singh D, Lawen J, Alkhudair W. Does pre­transplant obesity affect the outcome in kidney transplant recipients. Transplant Proc 2005;37: 717-20.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]
7.Hall JE, Brands MW, Henegar JR. Mechanisms of hypertension and kidney disease in obesity. Ann NY Acad Sci 1999;892:91-107.  Back to cited text no. 7  [PUBMED]  [FULLTEXT]
8.Kambham N, Markowits GS, Valeri AM, Lin J, D'Agati VD. Obesity related glomerulopathy: An emerging epidemic. Kidney Int 2001;59: 1498-509.  Back to cited text no. 8    
9.Byers T. Body weight and mortality. N Engl J Med 1995;333:723-4.  Back to cited text no. 9    
10.Kalantar-Zadeh K, Kopple JD. Obesity paradox in patients on maintenance dialysis. Contrib Nephrol 2006;151:57-69.  Back to cited text no. 10    
11.Drafts HH, Anjum MR, Wynn JJ, et al. The impact of pre-transplant obesity on renal transplant outcomes. Clin Transplant 1997;11: 493-6.  Back to cited text no. 11  [PUBMED]  
12.Salahudeen AK. Obesity and survival on dialysis. Am J Kidney Dis 2003;41:925-32.  Back to cited text no. 12  [PUBMED]  [FULLTEXT]
13.Kalantar-Zadeh K, Abbott KC, Salahudeen AK, Kilpatrick RD, Horwich TB. Survival advantages of obesity in dialysis patients. Am J Clin Nutr 2005;82:543-54.  Back to cited text no. 13    

Top
Correspondence Address:
Alireza Hamidian Jahromi
Senior House Officer in Transplant, Oxford Transplant Centre, Churchill Hospital, Roosevelt Drive, Headington, Oxford OX3 7LJ, United Kingdom

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PMID: 19414937

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    Abstract
    Introduction
    Patients and Methods
    Results
    Discussion
    Acknowledgement
    References
    Article Tables
 

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