Coronary events in obese hemodialysis patients before and after renal transplantation

Abstract

We examined the impact of obesity (BMI ≥30 kg/m(2) , n = 357) on prognosis in 1696 hemodialysis (HD) patients before and after renal transplantation (TX). End-points were coronary events, composite cardiovascular (CV) events, and death. Obese HD patients were older (55.9 ± 9.2 vs. 54.2 ± 11), had more diabetes (54% vs. 40%), dyslipidemia (49% vs. 30%), altered myocardial scan (38% vs. 31%), myocardial infarction (MI) (16% vs. 10%), coronary intervention (11% vs. 7%), higher total cholesterol (186 ± 52 vs. 169 ± 47), and triglycerides (219 ± 167 vs. 144 ± 91). Obese undergoing TX had more dyslipidemia (46% vs. 31%), angina (23% vs. 14%), MI (18% vs. 5%), increased total cholesterol (185 ± 56 vs. 172 ± 48), and triglycerides (237 ± 190 vs. 149 ± 100). Obesity was independently associated with coronary events (log-rank = 0.008, HR 2.55% CI 1.27-5.11) and death (log-rank 0.046, HR 1.52, % CI 1.007-2.30) in TX but not in HD. Obese HD patients had more risk factors and ischemic heart disease, but these characteristics did not interfere with prognosis. In TX patients, obesity predicts coronary events and death.

Hematocrit and mortality in hemodialysis patients: A registry analysis from the KiHeart Cohort

“…A prespecified comprehensive cardiovascular investigation was performed, as previously reported [15,16]. Patients underwent 12-lead resting EKG and transthoracic echocardiography as part of their evaluation.…”

Medical Contraindications to Transplant Listing in the USA: A Survey of Adult and Pediatric Heart, Kidney, Liver, and Lung Programs

“…Most obese end-stage renal disease patients gain a survival benefit from kidney transplantation, but this benefit is lower for patients with BMI C 40 kg/m 2 and is not demonstrated in black patients with BMI C 40 kg/m 2 [12]. Obesity in kidney transplantation increases the risk of delayed graft function, wound complications, longer hospital admissions, readmission, new onset diabetes, coronary events, and mortality post-transplant [13,14]. Pediatric kidney transplant patients with a BMI C 35 kg/ m 2 have a substantially increased risk of graft loss at 10 years [15].…”