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Trends, Social Context, and Transplant Implications of Obesity Among Incident Dialysis Patients in the United States
Journal article   Open access   Peer reviewed

Trends, Social Context, and Transplant Implications of Obesity Among Incident Dialysis Patients in the United States

Linda-Marie U. Lavenburg, Yuna Kim, Eric D. Weinhandl, Kirsten L. Johansen and Meera N. Harhay
Transplantation, v 106(11), pp E488-E498
01 Nov 2022
DOI: https://doi.org/10.1097/TP.0000000000004243
PMID: 35831929
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://journals.lww.com/transplantjournal/Fulltext/9900/Trends,_Social_Context,_and_Transplant.105.aspxView
Published, Version of Record (VoR) Open

Abstract

Immunology Life Sciences & Biomedicine Science & Technology Surgery Transplantation
Background. 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. Methods. 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. Results. 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 (p(interaction) < 0.001 for all). Conclusions. 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.

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18 citations in Web of Science
13 citations in Scopus

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UN Sustainable Development Goals (SDGs)

This publication has contributed to the advancement of the following goals:

#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
Web of Science research areas
Immunology
Surgery
Transplantation
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