Obesity Management in Kidney Transplant Candidates: Current Paradigms and Gaps in Knowledge.
Obesity Management in Kidney Transplant Candidates: Current Paradigms and Gaps in Knowledge.
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DOI：
10.1053/j.ackd.2021.09.009
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发表时间：
2021-11
影响因子：
2.9
通讯作者：
Harhay MN
中科院分区：
文献类型：
--
作者：
Lee JH;McDonald EO;Harhay MN
在这篇综述中，我们讨论了慢性和终末期肾病（ESKD）患者肥胖患病率增加的证据，以及对肾移植（KT）候选人选择和管理的影响。尽管肥胖和ESKD患者从KT中获得了生存和生活质量方面的益处，但研究表明，大多数KT项目都保持严格的体重指数（BMI）截止值，以确定移植资格。然而，BMI并不能区分内脏肥胖和肌肉质量，内脏肥胖会带来更高的心血管风险和围手术期和移植后不良结局的风险，肌肉质量在ESKD中具有保护作用。此外，对于肥胖ESKD患者在KT前减肥的要求应与众多研究结果相平衡，这些研究结果表明体重减轻是ESKD患者死亡的风险因素，与起始BMI无关。数据表明，KT与肥胖候选人保持透析相关的生存益处相关，尽管没有肥胖的受体具有更高的移植物功能延迟率和更长的移植住院时间。需要研究来确定KT候选人评估和风险分层的最佳身体成分指标。此外，需要ESKD特定的肥胖管理指南，以解决这种日益常见的疾病的神经，行为，社会经济和身体基础。
In this review, we discuss evidence of the increasing prevalence of obesity among people with chronic and end-stage kidney disease (ESKD) and implications for kidney transplant (KT) candidate selection and management. Although people with obesity and ESKD receive survival and quality-of-life benefits from KT, studies show that most KT programs maintain strict body mass index (BMI) cut-offs to determine transplant eligibility. However, BMI does not distinguish between visceral adiposity, which confers higher cardiovascular risks and risks of perioperative and adverse post-transplant outcomes, and muscle mass, which is protective in ESKD. Furthermore, requirements for ESKD patients with obesity to lose weight before KT should be balanced with the findings of numerous studies that show weight loss is a risk factor for death among ESKD patients, independent of starting BMI. Data suggest that KT is associated with survival benefits relative to remaining on dialysis for candidates with obesity, although recipients without obesity have higher delayed graft function rates and longer transplant hospitalizations. Research is needed to determine the optimal body composition metrics for KT candidacy assessments and risk stratification. In addition, ESKD-specific obesity management guidelines are needed that will address the neurologic, behavioral, socioeconomic, and physical underpinnings of this increasingly common disease.
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DOI：
10.1053/j.ajkd.2020.08.016
发表时间：
2021-03
期刊：
American journal of kidney diseases : the official journal of the National Kidney Foundation
影响因子：
--
作者：
Chintam K;Chang AR
通讯作者：
Chang AR
影响因子：
6.1
作者：
Cook, Sharlene A.;MacLaughlin, Helen;Macdougall, Iain C.
通讯作者：
Macdougall, Iain C.
影响因子：
0.9
作者：
Fellmann, Marie;Balssa, Loic;Kleinclauss, Francois
通讯作者：
Kleinclauss, Francois
影响因子：
6.1
作者：
Doshi, Megha;Streja, Elani;Chen, Joline L. T.
通讯作者：
Chen, Joline L. T.
影响因子：
2.9
作者：
Cohen, Jordana B.;Tewksbury, Colleen M.;Dumon, Kristoffel R.
通讯作者：
Dumon, Kristoffel R.