Abstract 2937: Association Of Low Body Mass Index And Weight Loss With Increased Mortality In 14,065 Transplant-wait-listed Hemodialysis Patients
Obese individuals with terminal heart failure (HF) or end-stage renal disease (ESRD) are often asked to lose weight prior to heart or kidney transplantation despite recent findings of “obesity paradox” or “reverse epidemiology” indicating survival advantages of obesity in HF and ESRD. We hypothesized that lower BMI and weight loss over time in transplant-waitlisted hemodialysis (HD) patients (pts) is associated with increased death risk during the waiting period. By linking the 5-yr (7/2001– 6/2006) national database of a large dialysis organization (DaVita) to the Scientific Registry of Transplant Recipients, we identified 14,065 HD pts, who were transplant-waitlisted but who did not receive any kidney transplantation over the 5-yr period. Time-dependent survival models examined associations of calendar-quarterly measured BMI (using 13-wk averaged post-HD dry weight) and the percentage of change in weight over 6 mo with survival adjusted for case-mix and time-varying surrogates of malnutrition-inflammation complex syndrome (MICS). The 14,065 HD pts were 59.7±15.4 yrs old and included 47% women and 39% diabetics. The 13-wk averaged BMI was 26.4±6.7 kg/m2. Unadjusted and adjusted survival analyses showed progressively greater survival with higher BMI>23 kg/m2 and higher death risk across weight loss increments: Obese transplant-waitlisted HD pts appear to have greater survival that is incrementally associated with higher height-adjusted-weight, whereas weight loss over time appears associated with increased death risk. These findings may question the benefit of recommending weight reduction during the pre-transplant waiting period in obese MHD pts.
This research has received full or partial funding support from the American Heart Association, AHA Western States Affiliate (California, Nevada & Utah).