American Journal of Kidney Diseases
Volume 56, Issue 1 , Pages 143-156 , July 2010

Obesity in Kidney Transplant Recipients and Candidates

  • Kavitha Potluri, MD
  • ,
  • Susan Hou, MD

      Affiliations

    • Corresponding Author InformationAddress correspondence to Susan Hou, MD, Professor of Medicine, Department of Nephrology and Hypertension, Loyola University Medical Center, 2160 S First Ave, Bldg 102, Rm 3661, Maywood, IL 60153

Received 23 September 2009 ,Accepted 5 January 2010.

References 

  1. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999-2004. JAMA. 2006;295(13):1549–1555
  2. Kramer HJ, Saranathan A, Luke A, et al. Increasing body mass index in the incident ESRD population. J Am Soc Nephrol. 2006;17(5):1453–1459
  3. Potluri K, Hou S, Leehey D, et al. Body mass index (BMI) and obesity prevalence continue to increase among patients initiating dialysis in the US. Abstract presented at the 41st Annual Scientific Meeting of the American Society of Nephrology; November 4-9, 2008; Philadelphia, PA.
  4. Kramer H, Tuttle KR, Leehey D, et al. Obesity management in adults with CKD. Am J Kidney Dis. 2009;53(1):151–165
  5. World Health Organization. Obesity: Preventing and Managing the Global Epidemic: Report of a WHO Consultation on Obesity. June 3-5, 1997. Geneva, Switzerland: WHO Press; 2000;
  6. Bigaard J, Frederiksen K, Tjønneland A, et al. Waist circumference and body composition in relation to all-cause mortality in middle aged men and women. Int J Obes. 2005;29(7):778–784
  7. Lear SA, Humphries KH, Kohli S, Chockalingam A, Frohlich JJ, Birmingham CL. Visceral adipose tissue accumulation differs according to ethnic background: results of the Multicultural Community Health Assessment Trial (M-CHAT). Am J Clin Nutr. 2007;86(2):353–359
  8. Elsayed EF, Tighiouart H, Weiner DE, et al. Waist to hip ratio and body mass index as risk factors for cardiovascular events in CKD. Am J Kidney Dis. 2008;52(1):49–57
  9. Orazio L, Armstrong K, Banks M, Johnson DW, Isbel NM, Hickman IJ. Central obesity is common in renal transplant recipients and is associated with increased prevalence of cardiovascular risk factors. Nutr Diet. 2007;64(3):200–206
  10. Hsu CY, McCulloch CE, Iribarren C, Darbinian J, Go AS. Body mass index and risk of end-stage renal disease. Ann Intern Med. 2006;144(1):21–28
  11. Ejerblad E, Fored MC, Lindblad P, Fryzek J, McLaughlin JK, Nyrén O. Obesity and risk for chronic renal failure. J Am Soc Nephrol. 2006;17(6):1695–1702
  12. Chen J, Muntner P, Hamm LL, et al. The metabolic syndrome and chronic kidney disease in US adults. Ann Intern Med. 2004;140(3):167–174
  13. Wahba IM, Mak RH. Obesity and obesity-initiated metabolic syndrome: mechanistic links to chronic kidney disease. Clin J Am Soc Nephrol. 2007;2(3):550–562
  14. Weisinger JR, Kempson RL, Eldridge L, Swenson RS. The nephrotic syndrome: a complication of massive obesity. Ann Intern Med. 1974;81(4):440–447
  15. Wesson DE, Kurtzmann NA, Frommer JP. Massive obesity and nephrotic proteinuria with a normal renal biopsy. Nephron. 1985;40(2):235–237
  16. Verani RR. Obesity-associated focal segmental glomerulosclerosis: pathological features of the lesion and relationship with cardiomegaly and hyperlipidemia. Am J Kidney Dis. 1992;20(6):629–634
  17. Bosma RJ, Krikken JA, Homan van der Heide JJ, de Jong PE, Navis GJ. Obesity and renal hemodynamics. Contrib Nephrol. 2006;151:184–202
  18. Chagnac A, Weinstein T, Korzets A, et al. Glomerular hemodynamics in severe obesity. Am J Phyiol Renal Physiol. 2000;278(5):F817–F822
  19. Praga M, Morales E. Obesity, proteinuria and progression of renal failure. Curr Opin Nephrol Hypertens. 2006;15(5):481–486
  20. Griffin KA, Kramer H, Bidani AK. Adverse renal consequences of obesity. Am J Physiol Renal Physiol. 2008;294(4):F685–F696
  21. Brenner BM, Milford EL. Nephron underdosing: a programmed cause of chronic renal allograft failure. Am J Kidney Dis. 1993;21(5 suppl 2):S66–S72
  22. Kasiske BL, Snyder JJ, Gilbertson D. Inadequate donor size in cadaver kidney transplantation. J Am Soc Nephrol. 2002;13(8):2152–2159
  23. el-Agroudy AE, Hassan NA, Bakr MA, Foda MA, Shokeir AA, Shehab el-Dein AB. Effect of donor/recipient body weight mismatch on patient and graft outcome in living-donor kidney transplantation. Am J Nephrol. 2003;23(5):294–299
  24. Friedman AN, Miskulin DC, Rosenberg IH, Levey AS. Demographics in overweight and obesity in patients at time of kidney transplantation. Am J Kidney Dis. 2003;41(2):480–487
  25. Johnson DW, Isbel NM, Brown MA, et al. The effect of obesity on renal transplant outcomes. Transplantation. 2002;74(5):675–681
  26. Singh D, Lawen J, Alkhudair W. Does pretransplant obesity affect the outcome in kidney transplant recipients?. Transplant Proc. 2005;37(2):717–720
  27. Meier-Kriesche H-U, 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. Clin Transplant. 2002;73(1):70–74
  28. Cacciola RA, Pujar K, Ilham MA, Puliatti C, Asderakis A, Chavez R. Effect of degree of obesity on renal transplant outcome. Transplant Proc. 2008;40(10):3408–3412
  29. Howard RJ, Thai VB, Patton PR, et al. Obese kidney transplant recipients have good outcomes. Transplant Proc. 2001;33(7-8):3420–3421
  30. Aker S, Ivens K, Grabensee B, Herring P. Cardiovascular risk factors and diseases after renal transplantation. Int Urol Nephrol. 1998;30(6):777–788
  31. Ojo AO, Hanson JA, Wolfe RA, Leichtman AB, Agodoa LY, Port FK. Long-term survival in renal transplant recipients with graft function. Kidney Int. 2000;57(1):307–313
  32. Gill IS, Hodge EE, Novick AC, Steinmuller DR, Garred D. Impact of obesity on renal transplantation. Transplant Proc. 1993;25(1 pt 2):1047–1048
  33. Modlin CS, Flechner SM, Goormastic M, et al. Should obese patients lose weight before receiving a kidney transplant?. Transplantation. 1997;64(4):599–604
  34. Halme L, Eklund B, Kyllönen L, Salmela K. Is obesity still a risk factor in renal transplantation?. Transplant Int. 1997;10(4):284–288
  35. Kasiske BL, Snyder JJ, Gilbertson D, Matas AJ. Diabetes mellitus after kidney transplantation in the United States. Am J Transplant. 2003;3(2):178–185
  36. Cosio FG, Pesavento TE, Osei K, Henry ML, Ferguson RM. Post-transplant diabetes mellitus: increasing incidence in renal allograft recipients transplanted in recent years. Kidney Int. 2001;59(2):732–737
  37. Mathew JT, Rao M, Job V, Ratnaswamy S, Jacob CK. Post-transplant hyperglycemia: a study of risk factors. Nephrol Dial Transplant. 2003;18(1):164–171
  38. Parikh CR, Klem P, Wong C, Yalavarthy R, Chan L. Obesity is an independent predictor of posttransplant diabetes mellitus. Transplant Proc. 2003;35(8):2922–2926
  39. Leavey SF, McCullough K, Hecking E, Goodkin D, Port FK, Young EW. Body mass index and mortality in ‘healthier’ as compared with ‘sicker’ hemodialysis patients: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant. 2001;16(12):2386–2394
  40. Alexander JW, Goodman H. Gastric bypass in chronic renal failure and renal transplant. Nutr Clin Pract. 2007;22(1):16–21
  41. Modanlou KA, Muthyala U, Xiao H, et al. Bariatric surgery among kidney transplant candidates and recipients: analysis of United States Renal Data System and literature review. Transplantation. 2009;87(8):1167–1173
  42. Glanton CW, Kao TC, Cruess D, Agodoa LY, Abbott KC. Impact of renal transplantation on survival in end-stage renal disease patients with elevated body mass index. Kidney Int. 2003;63(2):647–653
  43. Clunk JM, Lin YC, Curtis JJ. Variables affecting weight gain in renal transplant recipients. Am J Kidney Dis. 2001;38(2):349–353
  44. Baum CL, Thielke K, Westin E, Kogan E, Cicalese L, Benedetti E. Predictors of weight gain and cardiovascular risk in a cohort of racially diverse kidney transplant recipients. Nutrition. 2002;18(2):139–146
  45. Elster EA, Leeser DB, Morrissette C, et al. Obesity following kidney transplantation and steroid avoidance immunosuppression. Clin Transplant. 2008;22(3):354–359
  46. Rogers CC, Alloway RR, Buell JF, et al. Body weight alterations under early corticosteroid withdrawal and chronic corticosteroid therapy with modern immunosuppression. Transplantation. 2005;80(1):26–33
  47. Marcic S, Kramer H, Luke A, Holt DR, Hou SH. Risk factors for weight gain following renal transplantation. Abstract presented at 37th Annual Meeting of the American Society of Nephrology; October 29-November 1, 2004; St. Louis, MO.
  48. Ersoy A, Baran B, Ersoy C, Kahvecioglu S, Akdag I. Calcineurin inhibitors and post-transplant weight gain. Nephrology. 2008;13(5):433–439
  49. Merion RM, Twork AM, Rosenberg L, et al. Obesity and renal transplantation. Surg Gynecol Obstet. 1991;172(5):367–376
  50. Drafts HH, Anjum MR, Wynn JJ, Mulloy LL, Bowley JN, Humphries AL. The impact of pre-transplant obesity on renal transplant outcomes. Clin Transplant. 1997;11(5 pt 2):493–496
  51. Flechner SM, Kolbeinsson ME, Tam J, Lum B. The impact of body weight on cyclosporine pharmacokinetics in renal transplant recipients. Transplantation. 1989;47(5):806–810
  52. Kasap B, Soylu A, Türkmen M, Kavukçu S, Bora S, Gülay H. Effect of obesity and overweight on cyclosporine blood levels and renal functions in renal adolescent recipients. Transplant Proc. 2006;38(2):463–465
  53. Rodrigo E, de Cos MA, Sánchez B, et al. High initial blood levels of tacrolimus in overweight renal transplant recipients. Transplant Proc. 2005;37(3):1453–1454
  54. Yau W-P, Vathsala A, Lou H-X, Chan E. Is a standard fixed dose of mycophenolate mofetil ideal for all patients?. Nephrol Dial Transplant. 2007;22(12):3638–3645
  55. Knowler WC, Barrett-Connor E, Fowler SE, et al. Diabetes Prevention Program Research Group Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403
  56. Patel MG. The effect of dietary intervention on weight gains after renal transplantation. J Ren Nutr. 1998;8(3):137–141
  57. Jezior D, Krajewska M, Madziarska K, et al. Weight reduction in renal transplant recipients program: the first successes. Transplant Proc. 2007;39(9):2769–2771
  58. Courtney AE, O'Rourke DM, Maxwell AP. Rapidly progressive renal failure associated with successful pharmacotherapy for obesity. Nephrol Dial Transplant. 2007;22(2):621–623
  59. Colman E, Fossler M. Reduction in blood cyclosporine concentrations by orlistat. N Engl J Med. 2000;342(15):1141–1142
  60. Sally E, Robson M, Hayley W, et al. Drug interaction in a renal transplant patient: cyclosporin-Neoral and orlistat. Am J Kidney Dis. 2003;41(2):493–496
  61. Clerbaux G, Goffin E, Pirson Y. Interaction between sibutramine and cyclosporine. Am J Transplant. 2003;3(7):906
  62. DeMaria EJ. Bariatric surgery for morbid obesity. N Engl J Med. 2007;356(21):2176–2183
  63. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–1737
  64. Buch KE, El-Sabrout R, Butt KM. Complications of laparosopic gastric banding in renal transplant recipients: A case study. Transplant Proc. 2006;38(9):3109–3111
  65. Alexander JW, Goodman HR, Gersin K, et al. Gastric bypass in morbidly obese patients with chronic renal failure and kidney transplant. Transplantation. 2004;78(3):469–474
  66. Rogers CC, Alloway RR, Alexander JW, Cardi M, Trofe J, Vinks AA. Pharmacokinetics of mycophenolic acid, tacrolimus and sirolimus after gastric bypass surgery in end-stage renal disease and transplant patients: a pilot study. Clin Transplant. 2008;22(3):281–291
  67. Marterre WF, Hariharan S, First MR, Alexander JW. Gastric bypass in morbidly obese kidney transplant recipients. Clin Transplant. 1996;10(5):414–419
  68. Nasr SH, D'Agati VD, Said SM, et al. Oxalate nephropathy complicating Roux-en-Y gastric bypass: an underrecognized cause of irreversible renal failure. Clin J Am Soc Nephrol. 2008;3(6):1676–1683

 Originally published online as doi:10.1053/j.ajkd.2010.01.017 on May 10, 2010.

PII: S0272-6386(10)00488-9

doi: 10.1053/j.ajkd.2010.01.017

American Journal of Kidney Diseases
Volume 56, Issue 1 , Pages 143-156 , July 2010