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

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 w
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Contact: Carrie Bebermeyer
bebermcl@slu.edu
314-977-8015
Saint Louis University
Source:Eurekalert

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