Abstract 11170: Obesity and Prognosis of Patients on Hemodialysis and After Renal Transplantation
Introduction: Obesity is not associated with CV events and death and may even be protective in patients on hemodialysis (HD), contrary to observations in the general population. The reason for this apparent paradox is unknown, but necessarily involves chronic uremia.
Methods: We examined the impact of obesity (BMI > 30 Kg/m2) on prognosis in a cohort of 1696 HD patients on the waiting list for renal transplantation (TX) (54.4 ± 10.7 yo, 68% Whites, 61% males, 42% diabetics, 29% smokers, 33% dyslipidemic, 42% with associated CVD) before and after TX. TX was performed in 439 patients (26%). End-points were coronary events (MI, unstable angina and sudden death) and death by any cause.
Results: There were 357 patients with obesity (21%). Mean BMI were 32.7 ± 2.6 and 23.8 ± 3.0 for obese and non-obese, respectively. Obese patients on HD were older (55.9 ± 9.2 v 54.2 ± 11) and had an increased prevalence of diabetes (54% v 40%), dyslipidemia (49% v 30%), altered myocardial scan (38% v 31%), previous MI (16% v 10%) and coronary intervention (11% v 7%), higher total-cholesterol (186 ± 52 v 169 ± 47) and triglycerides (219 ± 167 v 144 ± 91). Obese TX patients had more dyslipidemia (46% v 31%), more individuals with angina (23% v 14%) and MI (18% v 5%), increased total-cholesterol (185 ± 56 v 172 ± 48) and triglycerides (237 ± 190 v 149 ± 100). P values were < 0.05 for all comparisons. Time on dialysis, sex, race, smoking, hypertension, arteriopathy, previous stroke and ≥ 70% coronary stenosis were not related to obesity. In HD patients the event-free survival and death were similar in obese and non-obese. However, in TX patients, obesity was associated with a higher incidence of early (6 months) coronary events (Log-rank= 0.002, HR 2.64 %CI 1.40-4.99) and death (Log-rank= 0.04, HR 1.48 %CI 1.01-2.17).
Conclusion: Obese HD patients had more risk factors and ischemic heart disease but these characteristics did not interfere with prognosis. However, after TX, obesity predicted early coronary events and death. The results suggest that obese CKD patients may be somehow protected against the consequences of myocardial ischemia while on dialysis but protection is lost right after TX. This fact must be considered when selecting patients for TX.
Author Disclosures: J. De Lima: None. L.W. Gowdak: None. F.J. de Paula: None. H.C. Muela: None. L.A. Bortolotto: None.
- © 2014 by American Heart Association, Inc.