Navigation Links
Are some patients too heavy for a new kidney?
Date:1/14/2013

ST. LOUIS In a research review article published in the American Journal of Nephrology, Saint Louis University investigators examined data from multiple studies to better understand how obesity, an epidemic in the U.S., impacts kidney transplant patients. The authors report that, even as some connections between weight and health outcomes are unknown or contradictory, there is evidence that obese kidney transplant patients don't do as well after surgery, experiencing more adverse outcomes, including wound infections, delayed graft function, graft failure, cardiac disease and increased costs.

Led by Krista Lentine, M.D., associate professor of internal medicine in nephrology and Betsy Tuttle-Newhall, M.D., director of abdominal transplant at SLU, the authors examined multiple studies and concluded that the health outcomes of patients with higher body mass indices (BMI) are not as good. In addition, they found several areas where more study is needed in order to make clear and consistent recommendations about kidney transplants for heavier patients.

"Lifestyle alterations that seem reasonable to improve health outcomes should be encouraged," Tuttle Newhall said. "Just as we require patients with alcoholic liver disease to stop drinking prior to transplant, it is reasonable to ask kidney transplant candidates to lose excess body fat and attempt to increase lean muscle mass by becoming more physically active and modifying their diet."

Lentine, who also holds an appointment in the Saint Louis University Center for Outcomes Research (SLUCOR), says the study points the way for future research to fill in gaps in our knowledge about how weight affects kidney transplant patients.

"Current guidelines from the American Society of Transplantation recommend a supervised weight loss regimen including a low-calorie diet, behavioral therapy, and a physical activity plan to achieve a body mass index (BMI) of less than 30 prior to kidney transplantation," Lentine said. "But, these guidelines also note that we don't have enough data to determine if some obese patients aren't appropriate candidates to receive kidney transplants at all.

"For this reason, current acceptable BMI limits for kidney transplant candidates vary across transplant centers."

The authors say future investigations should seek to determine the upper BMI limit at which point kidney transplantation should not be recommended for obese patients. In addition researchers note the limitations of BMI alone as a measure of body fat, and suggest further research using more refined measures.

While obese transplant recipients appear to have worse outcomes compared to normal weight recipients, the authors also note that many obese dialysis patients have better long-term survival after a transplant compared with remaining on dialysis.

In addition, doctors are aware of an "obesity paradox" when it comes to dialysis patients. Kidney patients on dialysis appear to benefit from extra fat, living longer than normal weight patients. Researchers do not know how extra weight provides a protective benefit, but believe that this relative benefit does not occur in transplant scenarios.

The benefit of losing weight prior to a kidney transplant also is unproven. More study is needed to determine whether intentional weight loss before surgery, including diet, exercise and bariatric surgery, does, in fact, improve outcomes. The current understanding is murky because the available data does not distinguish between weight lost deliberately, through healthy diet, exercise or bariatric surgery, and spontaneous weight loss due to illness.

Bariatric surgery, in particular, needs to be studied further. Dialysis patients face bigger risks from surgery and it is unknown if it serves to offset the apparent risks of obesity when performed prior to a kidney transplant.

"This review showed us where there are gaps in the existing research and where current data is too light to be able to draw solid conclusions," said Lentine. "These gaps are what 'outcomes research' is designed to remedy.

"We've figured out some key questions to ask so that we can help our patients have successful transplants and healthy lives."

BOTTOM LINE

  • Obesity appears to affect kidney transplant patients in a negative way, leading to complications during their recovery.
  • Kidney patients should know that their weight may affect the success of a transplant and should work with their doctor to manage it in a healthy way.
  • Doctors need future studies to examine the upper BMI limit at which kidney transplantation should not be recommended for obese patients, to refine ways of measuring obesity, and to define the benefits of losing weight prior to a kidney transplant.


'/>"/>
Contact: Carrie Bebermeyer
bebermcl@slu.edu
314-977-8015
Saint Louis University
Source:Eurekalert

Related medicine news :

1. Hasbro Children’s Hospital Opens Soft Play Area for Patients and their Families
2. Kidneys Sometimes Removed Needlessly in Patients With Rare Genetic Disorder
3. New Dentistry Website Hopes to Bring Smiles to New Patients
4. Study finds poorer outcomes for obese patients treated for lumbar disc herniation
5. Which Hospital Patients Need Drugs to Prevent Gastrointestinal Bleeding?
6. Immunotherapy reduces allergic patients sensitivity to peanuts
7. Helping patients navigate new cancer drugs
8. ISHLT issues new guidelines for care of mechanical circulatory support device patients
9. Lung cancer patients live longer if they use beta-blockers while receiving radiotherapy
10. Black and Hispanic patients less likely to complete substance abuse treatment, Penn study shows
11. Meds May Spur Compulsive Behaviors in Some Parkinsons Patients: Study
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:2/13/2016)... ... February 13, 2016 , ... The producers of Enterprises TV ... , The increasingly modern world of instantaneous consumption proves very convenient for businesses. ... such as oil and coal, which pollutes our air, water, and soil. It can ...
(Date:2/13/2016)... , ... February 13, 2016 , ... ... Outlook’s top Clinical Data Management Solution Providers list for its expertise in eClinical ... and domain expertise to serve the technology needs of global clients. DDi provides ...
(Date:2/12/2016)... ... February 12, 2016 , ... ... exclusively to funding innovative lymphoma research and serving the lymphoma community through a ... 250 members of South Florida’s philanthropic community at its 10th anniversary Fashion Luncheon ...
(Date:2/12/2016)... ... ... Coco Libre, the maker of coconut water beverages with a purpose, is ... Coco Libre will offer musicians and celebrities the company’s signature Organic Coconut Water, a ... suite, held this year at the W Hollywood Hotel, has become a pre-show “must” ...
(Date:2/12/2016)... (PRWEB) , ... February 12, 2016 , ... Fisher House ... Vegas Mayor John J. Lee, Nevada Military Support Alliance president Scott Bensing, and Peggy ... at the VA Southern Nevada Healthcare System. This will be the first Fisher ...
Breaking Medicine News(10 mins):
(Date:2/11/2016)... 2016 The primary goal of this research ... on the usage of liquid biopsy. Key information the ... - Timeframe of liquid biopsy adoption amidst future users ... organization type - Sample inflow to conduct liquid biopsy ... serum, and so on. - Correlation analysis of sample ...
(Date:2/11/2016)... 11, 2016 PRO-DEX, INC. (NasdaqCM: PDEX) today announced ... 31, 2015. The Company also filed its Quarterly Report on ... with the Securities and Exchange Commission today. ... --> --> Net sales ... million, or 95%, to $5.4 million from $2.8 million for ...
(Date:2/11/2016)... -- Kindred Biosciences, Inc. (NASDAQ: KIN ), a biopharmaceutical ... pets, today announced the submission to FDA of the ... (NADA) for Zimeta™ (dipyrone injection, KIND-012).  Positive topline results ... the control of pyrexia (fever) in horses were recently ... --> The Chemistry, Manufacturing, and Controls technical ...
Breaking Medicine Technology: