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Body Mass Index and Mortality in Kidney Transplant Recipients: A Systematic Review and Meta-Analysis
Open accessAbstract
BACKGROUND: A higher body mass index (BMI) seems to be linked to survival advantage in maintenance hemodialysis patients. However, it is uncertain if this 'obesity survival paradox' is also observed in kidney transplant recipients. Hence, we systematically reviewed the literature on the impact of pre-transplantation BMI on all-cause mortality in this population. METHODS: We searched MEDLINE, EMBASE, Web of Science, CINAHL, and Cochrane CENTRAL for relevant studies up to July 2013. Two investigators independently selected the studies using predefined criteria, abstracted the data from the included studies, and independently assessed each study's quality using the Newcastle-Ottawa Quality Assessment Scale. In addition to the qualitative synthesis, we quantitatively pooled the results of the studies with clinical, methodological, and statistical homogeneity. RESULTS: We screened 7,123 records, from which we included 11 studies (with a total of 305,392 participants) in this systematic review and 4 studies in the meta-analyses. In the only study that included children, obesity was linked to higher mortality in children of 6-12 years old. For adults, our meta-analyses indicated that compared to normal BMI, underweight [Hazard Ratio (HR): 1.09; 95% Confidence Interval (CI): 1.02-1.20], overweight (HR: 1.07; 95% CI: 1.04-1.12), and obese (HR: 1.20; 95% CI: 1.14-1.23) levels of BMI were associated with higher mortality. CONCLUSION: The presence of the obesity survival paradox is unlikely in kidney transplant recipients since both extremes of pre-transplantation BMI are linked to higher mortality in this population.
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“Regarding the association between obesity and graft loss as well as morbidity, the findings are controversial (6, 10–13).”
From Cognitive-behavioral and dietary weight loss intervention in adult kidney transplant recipients with overweight and obesity: Results of a pilot RCT study (Adi-KTx) (2023) · cites this paper as [10]
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“Overweight and obesity after KTx are strongly associated with adverse outcomes.”
From Cognitive-behavioral and dietary weight loss intervention in adult kidney transplant recipients with overweight and obesity: Results of a pilot RCT study (Adi-KTx) (2023) · cites this paper as [10]
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“They reported higher rates of complications early after transplantation, including delayed graft functioning and surgical complications as well as a higher rate of adverse long-term complications such as cardiovascular diseases.”
From Cognitive-behavioral and dietary weight loss intervention in adult kidney transplant recipients with overweight and obesity: Results of a pilot RCT study (Adi-KTx) (2023) · cites this paper as [10]
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Wolfe, R. A., Ashby, V. B., Milford, E. L., OJO, A. O., Ettenger, R. E., Agodoa, L. Y. C., Held, P. J., & Port, F. K. (1999) · New England Journal of Medicine · doi:10.1056/nejm199912023412303 · Cited by 5,370
Prospective Studies Collaboration (2009) · The Lancet · doi:10.1016/s0140-6736(09)60318-4 · Cited by 4,807
Poirier, P., Giles, T. D., Bray, G. A., Hong, Y., Stern, J. S., Pi-Sunyer, F. X., & Eckel, R. H. (2006) · Circulation · doi:10.1161/circulationaha.106.171016 · Cited by 3,165
Survival advantages of obesity in dialysis patients
Kalantar-Zadeh, K., Abbott, K. C., Salahudeen, A. K., Kilpatrick, R. D., & Horwich, T. B. (2005) · The American Journal of Clinical Nutrition · doi:10.1093/ajcn/81.3.543 · Cited by 610
THE IMPACT OF BODY MASS INDEX ON RENAL TRANSPLANT OUTCOMES
Meier‐Kriesche, H., Arndorfer, J. A., & Kaplan, B. E. (2002) · Transplantation · doi:10.1097/00007890-200201150-00013 · Cited by 546
Obesity Paradox in End-Stage Kidney Disease Patients
Park, J., Ahmadi, S., Streja, E., Molnar, M. Z., Flegal, K. M., Gillen, D. L., Kovesdy, C. P., & Kalantar‐Zadeh, K. (2013) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2013.10.005 · Cited by 383
Glanton, C. W., Kao, T., Cruess, D. F., Agodoa, L. Y. C., & Abbott, K. C. (2003) · Kidney International · doi:10.1046/j.1523-1755.2003.00761.x · Cited by 226
Effect of obesity on the outcome of kidney transplantation: a 20-year follow-up
Hoogeveen, E. K., Aalten, J., Rothman, K. J., Roodnat, J. I., Mallat, M. J. K., Borm, G., Weimar, W., Hoitsma, A. J., & de Fijter, J. W. (2011) · Transplantation · doi:10.1097/tp.0b013e3182100f3a · Cited by 196
Effects of Body Mass Index at Transplant on Outcomes of Kidney Transplantation
Chang, S. H., Coates, P. T., & McDonald, S. P. (2007) · Transplantation · doi:10.1097/01.tp.0000285290.77406.7b · Cited by 195
Associations of Pretransplant Weight and Muscle Mass with Mortality in Renal Transplant Recipients
Streja, E., Molnar, M. Z., Kovesdy, C. P., Bunnapradist, S., Jing, J., Nissenson, A. R., Mucsi, I., Danovitch, G. M., & Kalantar‐Zadeh, K. (2011) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.09131010 · Cited by 182
Cited by
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KDOQI clinical practice guideline for nutrition in CKD: 2020 update
Ikizler, T. A., Burrowes, J. D., Byham-Gray, L. D., Campbell, K. L., Carrero, J.-J., Chan, W., Fouque, D., Friedman, A. N., Ghaddar, S., Goldstein-Fuchs, D. J., et al. (2020) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2020.05.006 · Cited by 1,960
Clinical practice guideline exercise and lifestyle in chronic kidney disease
Baker, L. A., March, D. S., Wilkinson, T. J., Billany, R. E., BISHOP, N. C., Castle, E. M., Chilcot, J., Davies, M. D., Graham-Brown, M. P. M., Greenwood, S. A., et al. (2022) · BMC Nephrology · doi:10.1186/s12882-021-02618-1 · Cited by 289
The Obesity Paradox in Kidney Disease: How to Reconcile It With Obesity Management
Kalantar‐Zadeh, K., Rhee, C. M., Chou, J., Ahmadi, S., Park, J., Chen, J. L. T., & Amin, A. (2017) · Kidney International Reports · doi:10.1016/j.ekir.2017.01.009 · Cited by 238
Body composition phenotypes and obesity paradox
Prado, C. M. M., González, M. C., & Heymsfield, S. B. (2015) · Current Opinion in Clinical Nutrition & Metabolic Care · doi:10.1097/mco.0000000000000216 · Cited by 157
Reverse Epidemiology of Traditional Cardiovascular Risk Factors in the Geriatric Population
Ahmadi, S., Streja, E., Zahmatkesh, G., Streja, D. A., Kashyap, M. L., Moradi, H., Molnar, M. Z., Reddy, U. G., Amin, A., Kovesdy, C. P., et al. (2015) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2015.07.014 · Cited by 140
Metadata
- Authors
- Ahmadi, S.-F., Zahmatkesh, G., Streja, E., Molnar, M. Z., Rhee, C. M., Kovesdy, C. P., Gillen, D. L., Steiner, S., & Kalantar-Zadeh, K.
- Affiliations
- University of California, Irvine Medical Center (US)
- University of Tennessee Health Science Center (US)
- Memphis VA Medical Center (US)
- University of California, Irvine (US)
- ORCID
- Venue
- American Journal of Nephrology
- Publisher
- S. Karger AG
- Published
- 2014
- Volume
- 40
- Issue
- 4
- Pages
- 315-324
- ISSN
- 0250-8095 (ISSN-L)
- 1421-9670
- PMC
- PMC4319181
- OpenAlex
- W2083852602
- Cited by
- 103
- References
- 22
- Citations by year
- 2026: 6 · 2025: 7 · 2024: 6 · 2023: 7 · 2022: 9 · 2021: 13 · 2020: 6 · 2019: 7 · 2018: 11 · 2017: 9 · 2016: 8 · 2015: 13
- FWCI
- 1.81
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- American Journal of Nephrology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion, cc-by)
- Funders
- National Institutes of Health
- National Institute on Aging (R21AG047036)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK078106, R13DK094686, R01DK096920, R01DK095668, K24DK091419)
- Topics
- Health Sciences › Medicine › Transplantation › Renal Transplantation Outcomes and Treatments
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- body mass index, kidney transplant recipients, all-cause mortality, underweight, overweight, obesity, children, hemodialysis
- MeSH terms
- Adult, Child, Graft Survival, Humans, Body Mass Index, Kidney Transplantation
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