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Obesity and access to kidney transplantation in patients starting dialysis: A prospective cohort study
BACKGROUND: Obesity has been linked to poor access to medical care. Although scientific evidence suggest that kidney transplantation improves survival and quality of life in obese patients with end-stage renal disease (ESRD), few data exist on the impact of obesity on access to kidney transplantatio...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5426620/ https://www.ncbi.nlm.nih.gov/pubmed/28493926 http://dx.doi.org/10.1371/journal.pone.0176616 |
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author | Lassalle, Mathilde Fezeu, Léopold K. Couchoud, Cécile Hannedouche, Thierry Massy, Ziad A. Czernichow, Sébastien |
author_facet | Lassalle, Mathilde Fezeu, Léopold K. Couchoud, Cécile Hannedouche, Thierry Massy, Ziad A. Czernichow, Sébastien |
author_sort | Lassalle, Mathilde |
collection | PubMed |
description | BACKGROUND: Obesity has been linked to poor access to medical care. Although scientific evidence suggest that kidney transplantation improves survival and quality of life in obese patients with end-stage renal disease (ESRD), few data exist on the impact of obesity on access to kidney transplantation in this population. OBJECTIVES: We aimed to characterize the relationships between body mass index (BMI) at the start of dialysis, changes in BMI after the start of dialysis, and either access to kidney transplantation or overall mortality in dialysis or transplantation among ESRD patients. METHODS: Between 2002 and 2011, 19524 dialysis patients with ESRD were included in the study via the French nationwide Renal Epidemiology and Information Network. Data on sociodemographic factors, comorbidities and laboratory test results were recorded upon entry into the registry. BMI were obtained at the start of dialysis and then yearly. Cubic spline regression analyses provided a graphic evaluation of the relationships between BMI at the start of dialysis and outcomes. Joint models were used to evaluate the association between the change over time in BMI and outcomes. RESULTS: During a median follow-up of 20.3 months, 6634 patients underwent kidney transplantation. A BMI >31 kg/m(2) at the start of the dialysis was associated with a lower likelihood of receiving a kidney transplant, and the likelihood decreased even further with higher BMI values. For patients with BMI ≥30kg/m(2) at the start of the dialysis, a 1 kg/m(2) decrease in BMI during follow-up was associated with a 9% to 11% increase in the likelihood of receiving a transplant. There was an L-shaped relationship between BMI at the start of dialysis and overall mortality. We showed that obese patients with ESRD face barriers to the receipt of a kidney transplant without valid reasons. CONCLUSION: Greater attention to this issue would improve the fairness of the organ allocation process and might improve outcomes for obese patients with ESRD. |
format | Online Article Text |
id | pubmed-5426620 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-54266202017-05-25 Obesity and access to kidney transplantation in patients starting dialysis: A prospective cohort study Lassalle, Mathilde Fezeu, Léopold K. Couchoud, Cécile Hannedouche, Thierry Massy, Ziad A. Czernichow, Sébastien PLoS One Research Article BACKGROUND: Obesity has been linked to poor access to medical care. Although scientific evidence suggest that kidney transplantation improves survival and quality of life in obese patients with end-stage renal disease (ESRD), few data exist on the impact of obesity on access to kidney transplantation in this population. OBJECTIVES: We aimed to characterize the relationships between body mass index (BMI) at the start of dialysis, changes in BMI after the start of dialysis, and either access to kidney transplantation or overall mortality in dialysis or transplantation among ESRD patients. METHODS: Between 2002 and 2011, 19524 dialysis patients with ESRD were included in the study via the French nationwide Renal Epidemiology and Information Network. Data on sociodemographic factors, comorbidities and laboratory test results were recorded upon entry into the registry. BMI were obtained at the start of dialysis and then yearly. Cubic spline regression analyses provided a graphic evaluation of the relationships between BMI at the start of dialysis and outcomes. Joint models were used to evaluate the association between the change over time in BMI and outcomes. RESULTS: During a median follow-up of 20.3 months, 6634 patients underwent kidney transplantation. A BMI >31 kg/m(2) at the start of the dialysis was associated with a lower likelihood of receiving a kidney transplant, and the likelihood decreased even further with higher BMI values. For patients with BMI ≥30kg/m(2) at the start of the dialysis, a 1 kg/m(2) decrease in BMI during follow-up was associated with a 9% to 11% increase in the likelihood of receiving a transplant. There was an L-shaped relationship between BMI at the start of dialysis and overall mortality. We showed that obese patients with ESRD face barriers to the receipt of a kidney transplant without valid reasons. CONCLUSION: Greater attention to this issue would improve the fairness of the organ allocation process and might improve outcomes for obese patients with ESRD. Public Library of Science 2017-05-11 /pmc/articles/PMC5426620/ /pubmed/28493926 http://dx.doi.org/10.1371/journal.pone.0176616 Text en © 2017 Lassalle et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Lassalle, Mathilde Fezeu, Léopold K. Couchoud, Cécile Hannedouche, Thierry Massy, Ziad A. Czernichow, Sébastien Obesity and access to kidney transplantation in patients starting dialysis: A prospective cohort study |
title | Obesity and access to kidney transplantation in patients starting dialysis: A prospective cohort study |
title_full | Obesity and access to kidney transplantation in patients starting dialysis: A prospective cohort study |
title_fullStr | Obesity and access to kidney transplantation in patients starting dialysis: A prospective cohort study |
title_full_unstemmed | Obesity and access to kidney transplantation in patients starting dialysis: A prospective cohort study |
title_short | Obesity and access to kidney transplantation in patients starting dialysis: A prospective cohort study |
title_sort | obesity and access to kidney transplantation in patients starting dialysis: a prospective cohort study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5426620/ https://www.ncbi.nlm.nih.gov/pubmed/28493926 http://dx.doi.org/10.1371/journal.pone.0176616 |
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