Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: Kidney transplant (KT) programs may be more reluctant to accept transplant candidates with morbid obesity due to concerns about higher post-operative risks. We examined trends in morbid obesity among US incident dialysis patients, and the association between morbid obesity and access to the KT waiting list.
*Methods: Using data from the US Renal Data System, we included adults age ≥ 18 years who initiated dialysis in the US between January 1, 2007 and December 31, 2016 and survived ≥ 1 year. Those with missing data on body mass index (BMI) were excluded (N=72,879). We defined morbid obesity as BMI≥40 kg/m2 at dialysis initiation. Our outcome was KT wait-listing within 1 year after dialysis initiation. We fit logistic regression models of wait-listing by morbid obesity status, adjusted for age, race/ethnicity, sex, insurance, dialysis modality, diabetes, year, and region.
*Results: There were 908,570 incident dialysis patients included in the analysis. Overall, mean BMI of incident dialysis patients that survived ≥1 year increased during the study period, whereas mean BMI in the subset who were wait-listed for KT within 1 year (N = 123,459) plateaued and then declined after 2010 (Fig). The age, race/ethnicity, and sex-adjusted prevalence of morbid obesity increased from 9.4% in 2007 (95% Confidence Interval [CI] 9.2%-9.6%) to 10.9% in 2016 (95% CI 10.7%-11.0%), with the highest adjusted prevalence of morbid obesity in ESRD Network 9 (13.2% in Kentucky, Indiana, and Ohio). Compared to those with BMI<40 kg/m2, dialysis patients with morbid obesity were more likely to be younger (mean age, 58 vs 63 years), black (34% vs 29%), female (56% vs 41%), and Medicaid-enrolled (31% vs 26%) (p<0.001 for all). In the multivariable adjusted logistic regression model, compared to incident dialysis patients with BMI<40 kg/m2, those with morbid obesity were nearly two-thirds less likely to be wait-listed for KT within 1 year of dialysis (adjusted odds ratio 0.36, 95% CI 0.35-0.37, p<0.001).
*Conclusions: Among US incident dialysis patients, morbid obesity is increasingly common. Dialysis-dependent adults with morbid obesity are substantially less likely than their counterparts with lower BMI to be wait-listed for KT within 1 year of starting dialysis.
To cite this abstract in AMA style:Lavenburg L, Weinhandl E, Robinson L, Milliron B, Earthman C, Klassen A, Harhay M. Morbid Obesity: A Growing Barrier to Early Kidney Transplant Wait-Listing in the United States [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/morbid-obesity-a-growing-barrier-to-early-kidney-transplant-wait-listing-in-the-united-states/. Accessed November 28, 2020.
« Back to 2020 American Transplant Congress