Renal and Electrolyte Division, Department of Medicine, University of Pennsylvania, Philadelphia, PA.
Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA.
Transplantation. 2022 Nov 1;106(11):e488-e498. doi: 10.1097/TP.0000000000004243. Epub 2022 Jul 14.
Kidney transplant programs have variable thresholds to accept obese candidates. This study aimed to examine trends and the social context of obesity among United States dialysis patients and implications for kidney transplant access.
We performed a retrospective cohort study of 1 084 816 adults who initiated dialysis between January 2007 and December 2016 using the United States Renal Data System data. We estimated national body mass index (BMI) trends and 1-y cumulative incidence of waitlisting and death without waitlisting by BMI category (<18.5 kg/m 2 , ≥18.5 and <25 kg/m 2 [normal weight], ≥25 and <30 kg/m 2 [overweight], ≥30 and <35 kg/m 2 [class 1 obesity], ≥35 and <40 kg/m 2 [class 2 obesity], and ≥40 kg/m 2 [class 3 obesity]). We then used Fine-Gray subdistribution hazard regression models to examine associations between BMI category and 1-y waitlisting with death as a competing risk and tested for effect modification by End Stage Renal Disease (ESRD) network, patient characteristics, and neighborhood social deprivation index.
The median age was 65 (interquartile range 54-75) y, 43% were female, and 27% were non-Hispanic Black. From 2007 to 2016, the adjusted prevalence of class 1 obesity or higher increased from 31.9% to 38.2%. Class 2 and 3 obesity but not class 1 obesity were associated with lower waitlisting rates relative to normal BMI, especially for younger individuals, women, those of Asian race, or those living in less disadvantaged neighborhoods ( pinteraction < 0.001 for all).
Obesity prevalence is rising among US incident dialysis patients. Relative to normal BMI, waitlisting rates with class 2 and 3 obesity were lower and varied substantially by region, patient characteristics, and socioeconomic context.
肾脏移植项目对接受肥胖候选人的标准存在差异。本研究旨在调查美国透析患者肥胖的趋势和社会背景，以及其对肾脏移植机会的影响。
我们对 2007 年 1 月至 2016 年 12 月期间通过美国肾脏数据系统登记的 1084816 名开始透析的成年人进行了回顾性队列研究。我们根据体重指数（BMI）类别估计了全国 BMI 趋势，以及 BMI 类别（<18.5kg/m 2 、≥18.5 且<25kg/m 2 [正常体重]、≥25 且<30kg/m 2 [超重]、≥30 且<35kg/m 2 [1 类肥胖]、≥35 且<40kg/m 2 [2 类肥胖]和≥40kg/m 2 [3 类肥胖]）的 1 年累积列入等待名单和无等待名单死亡的发生率。然后，我们使用 Fine-Gray 亚分布风险回归模型来检验 BMI 类别与 1 年等待名单之间的关联，并将死亡作为竞争风险，同时检验 ESRD 网络、患者特征和社区社会剥夺指数的作用修饰。
中位年龄为 65（四分位间距为 54-75）岁，43%为女性，27%为非西班牙裔黑人。从 2007 年到 2016 年，1 类或更高水平肥胖的调整后患病率从 31.9%增加到 38.2%。与正常 BMI 相比，2 类和 3 类肥胖而非 1 类肥胖与较低的等待名单率相关，尤其是对于年龄较小、女性、亚裔或生活在社会劣势程度较低的社区的患者（所有 p 交互值均<0.001）。
在美国新确诊的透析患者中，肥胖的患病率正在上升。与正常 BMI 相比，2 类和 3 类肥胖的等待名单率较低，且在区域、患者特征和社会经济背景方面差异很大。
