Cofán F, Vela E, Clèries M
Renal Transplant Unit, Hospital Clinic, Barcelona, Spain.
Transplant Proc. 2005 Nov;37(9):3695-7. doi: 10.1016/j.transproceed.2005.10.069.
Obesity is a cardiovascular risk factor in renal transplantation (RT). The objective of this study was to analyze the prevalence of post-RT obesity and risk factors associated with its development.
The study included all patients with a functioning renal transplant on December 31, 2003, who were residents of Catalonia, aged older than 14 years and who underwent transplantation between 1990 and 2003 (n = 2793); 102 patients (3.7%) were excluded due to lack of data for 1 or more study variables. Mean age was 53 +/- 14 years (range, 15-83) (61% men). Mean transplant duration was 63.0 +/- 44.5 months (range, 0-168). The chi-square test was used to compare proportions, analysis of variance (ANOVA) to compare mean values, and logistic regression to study risk factors for post-RT obesity. All data were taken from the Renal Registry of Catalonia (RMRC).
Among RT patients, 38% were overweight (body mass index [BMI], 25-29.9 kg/m(2)) and 16% were obese (BMI >30). Prevalence of obesity was higher in women (21% vs 13%; P < .0001). Age was associated with obesity in RT patients aged 45-64 (20%) and 65-74 (18%) with respect to the group aged 15-44 years (9%) or >74 years (13%) (P < .0001). A total of 26% of patients who were normal weight before RT (BMI, 20-24.9) became overweight post-RT and 6% developed obesity (P < .0001). Among patients who were overweight pre-RT, 68% persisted with post-RT excess weight and 16% progressed to obesity (P < .0001). In the multivariate study, significant risk factors for developing post-RT obesity included the following: female (relative risk [RR], 2.46; P < .0001), age (45-64 years; RR, 2.36; P < .0001; and 65-74 years; RR, 2.23; P = .002), high blood pressure (RR, 1.44; P = .03), duration of transplant (RR, 1.06; P < .0001), cardiomyopathy (RR, 1.51; P = .007), and, particularly, the presence of excess weight (RR, 2.69; P < .0001) and pre-RT obesity (RR, 59.02; P < .0001).
There is a high prevalence of post-RT excess weight and obesity. Adequate control of cardiovascular risk in renal transplant recipients should also include strict measures to prevent and treat obesity.
肥胖是肾移植（RT）中的一个心血管危险因素。本研究的目的是分析肾移植后肥胖的患病率及其发生的相关危险因素。
本研究纳入了2003年12月31日所有肾功能正常的肾移植患者，这些患者为加泰罗尼亚居民，年龄大于14岁，于1990年至2003年间接受移植（n = 2793）；102例患者（3.7%）因缺乏1个或更多研究变量的数据而被排除。平均年龄为53±14岁（范围15 - 83岁）（男性占61%）。平均移植时间为63.0±44.5个月（范围0 - 168个月）。采用卡方检验比较比例，方差分析（ANOVA）比较均值，逻辑回归分析研究肾移植后肥胖的危险因素。所有数据均来自加泰罗尼亚肾脏登记处（RMRC）。
在肾移植患者中，38%超重（体重指数[BMI]，25 - 29.9 kg/m²），16%肥胖（BMI>30）。女性肥胖患病率更高（21%对13%；P<.0001）。45 - 64岁（20%）和65 - 74岁（18%）的肾移植患者肥胖与15 - 44岁组（9%）或>74岁组（13%）相比（P<.0001）。肾移植前体重正常（BMI，20 - 24.9）的患者中，26%肾移植后超重，6%发展为肥胖（P<.0001）。肾移植前超重的患者中，68%肾移植后仍超重，16%进展为肥胖（P<.0001）。在多变量研究中，肾移植后发生肥胖的显著危险因素包括：女性（相对危险度[RR]，2.46；P<.0001）、年龄（45 - 64岁；RR，2.36；P<.0001；65 - 74岁；RR，2.23；P =.002）、高血压（RR，1.44；P =.03）、移植时间（RR，1.06；P<.0001）、心肌病（RR，1.51；P =.007），尤其是超重的存在（RR，2.69；P<.0001）和肾移植前肥胖（RR，59.02；P<.0001）。
肾移植后超重和肥胖的患病率很高。肾移植受者心血管风险的充分控制还应包括预防和治疗肥胖的严格措施。
