Demographics and trends in overweight and obesity in patients at time of kidney transplantation

Background: The epidemic of overweight and obesity is one of the most serious public health problems in the United States, although information regarding its effect on chronic kidney transplant patients is sparse. The authors describe the prevalence, demographics, and trends in overweight and obesity at the time of kidney transplantation. Methods: Data were obtained from a national transplant database that included all kidney transplants since 1987. Body mass indices (BMI) at time of transplantation were stratified by demographic categories and year. Trends of overweight and obesity between the general population and subjects undergoing kidney transplantation were compared. Logistic regression analyses were performed to identify variables associated with increased likelihood of being obese. Results: The majority (60%) of subjects at time of transplantation currently are overweight or obese. Between 1987 and 2001, the proportion of obese transplant recipients rose by 116%. The rate of increase was grossly similar to that in the general population. The likelihood of being obese increased with age, female sex, noninsulin-dependent diabetes mellitus, black race, and the more recent the transplant year. Conversely, the proportion of recipients with lower BMI fell by approximately 50%. Conclusions: Overweight and obesity are very prevalent at the time of kidney transplantation and are eclipsing protein-energy malnutrition as the more common nutritional illness. This may have profound negative effects on patient and allograft outcomes. Nephrologists may need to reexamine traditional notions of nutritional disease and therapeutic strategies to more effectively deal with this formidable challenge.