Journal article
The impact of kidney transplantation on heart failure risk varies with candidate body mass index
The American heart journal, Vol.158(6), pp.972-982
12/01/2009
DOI: 10.1016/j.ahj.2009.10.009
PMCID: PMC2804249
PMID: 19958864
Abstract
Background The relationship of body mass index (BMI) with heart failure (HF) risk before and after kidney transplant is not well described.
Methods We examined United States Renal Data System records for 67,591 kidney transplant candidates (1995-2004) with Medicare insurance and BMI data at listing. Heart failure diagnoses were ascertained from Medicare billing claims. Body mass index was categorized per World Health Organization criteria. We modeled time-dependent associations (adjusted hazard ratio, aHR) of transplant with HF risk after listing compared with waiting in each BMI group by multivariable, stratified Cox regression. The time-dependent exposure variables partitioned relative risk of HF after transplant versus waiting into early (<= 90 days) and late (> 90 days) posttransplant periods.
Results The BMI distribution of listed candidates was as follows: 3.7% under, 40.4% normal, 32.0% over, 16.2% obese, and 7.7% morbidly obese weight. The prevalence of HF among patients awaiting transplant reached 57.4% by 3 years. Deceased-donor transplant was associated with increased early HF risk compared with continued waiting-aHRs ranged from 2.23 for normal-BMI to 2.82 for morbidly obese patients. However, transplant reduced the risk of HF in the late posttransplant period from 54% (aHR 0.46) in normal-BMI to 32% (aHR 0.68) for morbidly obese patients. Relative benefits were largest for normal-weight candidates who received live-donor transplants (aHR 0.31).
Conclusions Heart failure risk improves in obese patients in the long term after kidney transplant, but not as much as for nonobese patients. There is need for close monitoring and for new strategies to reduce HF risk in obese patients before and after transplant. (Am Heart J 2009; 158: 972-82.)
Details
- Title: Subtitle
- The impact of kidney transplantation on heart failure risk varies with candidate body mass index
- Creators
- Krista L. Lentine - Saint Louis UniversityHuiling Xiao - Saint Louis UniversityDaniel C. Brennan - Washington University in St. LouisMark A. Schnitzler - Saint Louis UniversityTodd C. Villines - Walter Reed National Military Medical CenterKevin C. Abbott - Walter Reed National Military Medical CenterDavid Axelrod - Dartmouth–Hitchcock Medical CenterJon J. SnyderPaul J. Hauptman - Saint Louis University
- Resource Type
- Journal article
- Publication Details
- The American heart journal, Vol.158(6), pp.972-982
- DOI
- 10.1016/j.ahj.2009.10.009
- PMID
- 19958864
- PMCID
- PMC2804249
- NLM abbreviation
- Am Heart J
- ISSN
- 0002-8703
- eISSN
- 1097-6744
- Publisher
- Elsevier
- Number of pages
- 11
- Grant note
- K08 DK073036-04; K08 DK073036; P30 DK079333 / NIDDK NIH HHS; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK) K08DK073036 / NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK)
- Language
- English
- Date published
- 12/01/2009
- Academic Unit
- Surgery
- Record Identifier
- 9984322802102771
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