TY - JOUR
T1 - The impact of kidney transplantation on heart failure risk varies with candidate body mass index
AU - Lentine, Krista L.
AU - Xiao, Huiling
AU - Brennan, Daniel C.
AU - Schnitzler, Mark A.
AU - Villines, Todd C.
AU - Abbott, Kevin C.
AU - Axelrod, David
AU - Snyder, Jon J.
AU - Hauptman, Paul J.
N1 - Funding Information:
This work was approved by the Institutional Review Board of Saint Louis University. Dr Lentine received support from a grant from the National Institute of Diabetes Digestive and Kidney Diseases (NIDDK), K08DK073036. Drs Brennan and Schnitzler received support from a grant from the NIDDK, P30DK079333. The authors are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the paper, and its final contents.
PY - 2009/12
Y1 - 2009/12
N2 - Background: The relationship of body mass index (BMI) with heart failure (HF) risk before and after kidney transplant is not well described. Methods: We examined United States Renal Data System records for 67,591 kidney transplant candidates (1995-2004) with Medicare insurance and BMI data at listing. Heart failure diagnoses were ascertained from Medicare billing claims. Body mass index was categorized per World Health Organization criteria. We modeled time-dependent associations (adjusted hazard ratio, aHR) of transplant with HF risk after listing compared with waiting in each BMI group by multivariable, stratified Cox regression. The time-dependent exposure variables partitioned relative risk of HF after transplant versus waiting into early (≤90 days) and late (>90 days) posttransplant periods. Results: The BMI distribution of listed candidates was as follows: 3.7% under, 40.4% normal, 32.0% over, 16.2% obese, and 7.7% morbidly obese weight. The prevalence of HF among patients awaiting transplant reached 57.4% by 3 years. Deceased-donor transplant was associated with increased early HF risk compared with continued waiting-aHRs ranged from 2.23 for normal-BMI to 2.82 for morbidly obese patients. However, transplant reduced the risk of HF in the late posttransplant period from 54% (aHR 0.46) in normal-BMI to 32% (aHR 0.68) for morbidly obese patients. Relative benefits were largest for normal-weight candidates who received live-donor transplants (aHR 0.31). Conclusions: Heart failure risk improves in obese patients in the long term after kidney transplant, but not as much as for nonobese patients. There is need for close monitoring and for new strategies to reduce HF risk in obese patients before and after transplant.
AB - Background: The relationship of body mass index (BMI) with heart failure (HF) risk before and after kidney transplant is not well described. Methods: We examined United States Renal Data System records for 67,591 kidney transplant candidates (1995-2004) with Medicare insurance and BMI data at listing. Heart failure diagnoses were ascertained from Medicare billing claims. Body mass index was categorized per World Health Organization criteria. We modeled time-dependent associations (adjusted hazard ratio, aHR) of transplant with HF risk after listing compared with waiting in each BMI group by multivariable, stratified Cox regression. The time-dependent exposure variables partitioned relative risk of HF after transplant versus waiting into early (≤90 days) and late (>90 days) posttransplant periods. Results: The BMI distribution of listed candidates was as follows: 3.7% under, 40.4% normal, 32.0% over, 16.2% obese, and 7.7% morbidly obese weight. The prevalence of HF among patients awaiting transplant reached 57.4% by 3 years. Deceased-donor transplant was associated with increased early HF risk compared with continued waiting-aHRs ranged from 2.23 for normal-BMI to 2.82 for morbidly obese patients. However, transplant reduced the risk of HF in the late posttransplant period from 54% (aHR 0.46) in normal-BMI to 32% (aHR 0.68) for morbidly obese patients. Relative benefits were largest for normal-weight candidates who received live-donor transplants (aHR 0.31). Conclusions: Heart failure risk improves in obese patients in the long term after kidney transplant, but not as much as for nonobese patients. There is need for close monitoring and for new strategies to reduce HF risk in obese patients before and after transplant.
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U2 - 10.1016/j.ahj.2009.10.009
DO - 10.1016/j.ahj.2009.10.009
M3 - Article
C2 - 19958864
AN - SCOPUS:70549106490
SN - 0002-8703
VL - 158
SP - 972
EP - 982
JO - American Heart Journal
JF - American Heart Journal
IS - 6
ER -