Associations of pretransplant weight and muscle mass with mortality in renal transplant recipients

Elani Streja, Miklos Z. Molnar, Csaba Kovesdy, Suphamai Bunnapradist, Jennie Jing, Allen R. Nissenson, Istvan Mucsi, Gabriel M. Danovitch, Kamyar Kalantar-Zadeh

Research output: Contribution to journalArticle

93 Citations (Scopus)

Abstract

Background and objectives: The association between pretransplant body composition and posttransplant outcomes in renal transplant recipients is unclear. It was hypothesized that in hemodialysis patients higher muscle mass (represented by higher pretransplant serum creatinine level) and larger body size (represented by higher pretransplant body mass index [BMI]) are associated with better posttransplant outcomes. Design, setting, participants, & measurements: Linking 5-year patient data of a large dialysis organization (DaVita) to the Scientific Registry of Transplant Recipients, 10,090 hemodialysis patients were identified who underwent kidney transplantation from July 2001 to June 2007. Cox regression hazard ratios and 95% confidence intervals of death and/or graft failure were estimated. Results: Patients were 49 ± 13 years old and included 49% women, 45% diabetics, and 27% African Americans. In Cox models adjusted for case-mix, nutrition-inflammation complex, and transplant-related covariates, the 3-month-averaged postdialysis weight-based pretransplant BMI of 20 to <22 and < 20 kg/m2, compared with 22 to <25 kg/m2, showed a nonsignificant trend toward higher combined posttransplant mortality or graft failure, and even weaker associations existed for BMI ≥ 25 kg/m2. Compared with pretransplant 3-month- averaged serum creatinine of 8 to <10 mg/dl, there was 2.2-fold higher risk of combined death or graft failure with serum creatinine ≥4 mg/dl, whereas creatinine ≥14 mg/dl exhibited 22% better graft and patient survival. Conclusions: Pretransplant obesity does not appear to be associated with poor posttransplant outcomes. Larger pretransplant muscle mass, reflected by higher pretransplant serum creatinine level, is associated with greater posttransplant graft and patient survival.& copy 2011 by the American Society of Nephrology.

Original languageEnglish (US)
Pages (from-to)1463-1473
Number of pages11
JournalClinical Journal of the American Society of Nephrology
Volume6
Issue number6
DOIs
StatePublished - Jun 1 2011

Fingerprint

Creatinine
Kidney
Weights and Measures
Muscles
Mortality
Transplants
Body Mass Index
Graft Survival
Serum
Renal Dialysis
Diagnosis-Related Groups
Body Size
Body Composition
Proportional Hazards Models
African Americans
Kidney Transplantation
Registries
Transplant Recipients
Dialysis
Obesity

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

Cite this

Associations of pretransplant weight and muscle mass with mortality in renal transplant recipients. / Streja, Elani; Molnar, Miklos Z.; Kovesdy, Csaba; Bunnapradist, Suphamai; Jing, Jennie; Nissenson, Allen R.; Mucsi, Istvan; Danovitch, Gabriel M.; Kalantar-Zadeh, Kamyar.

In: Clinical Journal of the American Society of Nephrology, Vol. 6, No. 6, 01.06.2011, p. 1463-1473.

Research output: Contribution to journalArticle

Streja, E, Molnar, MZ, Kovesdy, C, Bunnapradist, S, Jing, J, Nissenson, AR, Mucsi, I, Danovitch, GM & Kalantar-Zadeh, K 2011, 'Associations of pretransplant weight and muscle mass with mortality in renal transplant recipients', Clinical Journal of the American Society of Nephrology, vol. 6, no. 6, pp. 1463-1473. https://doi.org/10.2215/CJN.09131010
Streja, Elani ; Molnar, Miklos Z. ; Kovesdy, Csaba ; Bunnapradist, Suphamai ; Jing, Jennie ; Nissenson, Allen R. ; Mucsi, Istvan ; Danovitch, Gabriel M. ; Kalantar-Zadeh, Kamyar. / Associations of pretransplant weight and muscle mass with mortality in renal transplant recipients. In: Clinical Journal of the American Society of Nephrology. 2011 ; Vol. 6, No. 6. pp. 1463-1473.
@article{1fee1d32686540ca8afc706ee7e20936,
title = "Associations of pretransplant weight and muscle mass with mortality in renal transplant recipients",
abstract = "Background and objectives: The association between pretransplant body composition and posttransplant outcomes in renal transplant recipients is unclear. It was hypothesized that in hemodialysis patients higher muscle mass (represented by higher pretransplant serum creatinine level) and larger body size (represented by higher pretransplant body mass index [BMI]) are associated with better posttransplant outcomes. Design, setting, participants, & measurements: Linking 5-year patient data of a large dialysis organization (DaVita) to the Scientific Registry of Transplant Recipients, 10,090 hemodialysis patients were identified who underwent kidney transplantation from July 2001 to June 2007. Cox regression hazard ratios and 95{\%} confidence intervals of death and/or graft failure were estimated. Results: Patients were 49 ± 13 years old and included 49{\%} women, 45{\%} diabetics, and 27{\%} African Americans. In Cox models adjusted for case-mix, nutrition-inflammation complex, and transplant-related covariates, the 3-month-averaged postdialysis weight-based pretransplant BMI of 20 to <22 and < 20 kg/m2, compared with 22 to <25 kg/m2, showed a nonsignificant trend toward higher combined posttransplant mortality or graft failure, and even weaker associations existed for BMI ≥ 25 kg/m2. Compared with pretransplant 3-month- averaged serum creatinine of 8 to <10 mg/dl, there was 2.2-fold higher risk of combined death or graft failure with serum creatinine ≥4 mg/dl, whereas creatinine ≥14 mg/dl exhibited 22{\%} better graft and patient survival. Conclusions: Pretransplant obesity does not appear to be associated with poor posttransplant outcomes. Larger pretransplant muscle mass, reflected by higher pretransplant serum creatinine level, is associated with greater posttransplant graft and patient survival.& copy 2011 by the American Society of Nephrology.",
author = "Elani Streja and Molnar, {Miklos Z.} and Csaba Kovesdy and Suphamai Bunnapradist and Jennie Jing and Nissenson, {Allen R.} and Istvan Mucsi and Danovitch, {Gabriel M.} and Kamyar Kalantar-Zadeh",
year = "2011",
month = "6",
day = "1",
doi = "10.2215/CJN.09131010",
language = "English (US)",
volume = "6",
pages = "1463--1473",
journal = "Clinical journal of the American Society of Nephrology : CJASN",
issn = "1555-9041",
publisher = "American Society of Nephrology",
number = "6",

}

TY - JOUR

T1 - Associations of pretransplant weight and muscle mass with mortality in renal transplant recipients

AU - Streja, Elani

AU - Molnar, Miklos Z.

AU - Kovesdy, Csaba

AU - Bunnapradist, Suphamai

AU - Jing, Jennie

AU - Nissenson, Allen R.

AU - Mucsi, Istvan

AU - Danovitch, Gabriel M.

AU - Kalantar-Zadeh, Kamyar

PY - 2011/6/1

Y1 - 2011/6/1

N2 - Background and objectives: The association between pretransplant body composition and posttransplant outcomes in renal transplant recipients is unclear. It was hypothesized that in hemodialysis patients higher muscle mass (represented by higher pretransplant serum creatinine level) and larger body size (represented by higher pretransplant body mass index [BMI]) are associated with better posttransplant outcomes. Design, setting, participants, & measurements: Linking 5-year patient data of a large dialysis organization (DaVita) to the Scientific Registry of Transplant Recipients, 10,090 hemodialysis patients were identified who underwent kidney transplantation from July 2001 to June 2007. Cox regression hazard ratios and 95% confidence intervals of death and/or graft failure were estimated. Results: Patients were 49 ± 13 years old and included 49% women, 45% diabetics, and 27% African Americans. In Cox models adjusted for case-mix, nutrition-inflammation complex, and transplant-related covariates, the 3-month-averaged postdialysis weight-based pretransplant BMI of 20 to <22 and < 20 kg/m2, compared with 22 to <25 kg/m2, showed a nonsignificant trend toward higher combined posttransplant mortality or graft failure, and even weaker associations existed for BMI ≥ 25 kg/m2. Compared with pretransplant 3-month- averaged serum creatinine of 8 to <10 mg/dl, there was 2.2-fold higher risk of combined death or graft failure with serum creatinine ≥4 mg/dl, whereas creatinine ≥14 mg/dl exhibited 22% better graft and patient survival. Conclusions: Pretransplant obesity does not appear to be associated with poor posttransplant outcomes. Larger pretransplant muscle mass, reflected by higher pretransplant serum creatinine level, is associated with greater posttransplant graft and patient survival.& copy 2011 by the American Society of Nephrology.

AB - Background and objectives: The association between pretransplant body composition and posttransplant outcomes in renal transplant recipients is unclear. It was hypothesized that in hemodialysis patients higher muscle mass (represented by higher pretransplant serum creatinine level) and larger body size (represented by higher pretransplant body mass index [BMI]) are associated with better posttransplant outcomes. Design, setting, participants, & measurements: Linking 5-year patient data of a large dialysis organization (DaVita) to the Scientific Registry of Transplant Recipients, 10,090 hemodialysis patients were identified who underwent kidney transplantation from July 2001 to June 2007. Cox regression hazard ratios and 95% confidence intervals of death and/or graft failure were estimated. Results: Patients were 49 ± 13 years old and included 49% women, 45% diabetics, and 27% African Americans. In Cox models adjusted for case-mix, nutrition-inflammation complex, and transplant-related covariates, the 3-month-averaged postdialysis weight-based pretransplant BMI of 20 to <22 and < 20 kg/m2, compared with 22 to <25 kg/m2, showed a nonsignificant trend toward higher combined posttransplant mortality or graft failure, and even weaker associations existed for BMI ≥ 25 kg/m2. Compared with pretransplant 3-month- averaged serum creatinine of 8 to <10 mg/dl, there was 2.2-fold higher risk of combined death or graft failure with serum creatinine ≥4 mg/dl, whereas creatinine ≥14 mg/dl exhibited 22% better graft and patient survival. Conclusions: Pretransplant obesity does not appear to be associated with poor posttransplant outcomes. Larger pretransplant muscle mass, reflected by higher pretransplant serum creatinine level, is associated with greater posttransplant graft and patient survival.& copy 2011 by the American Society of Nephrology.

UR - http://www.scopus.com/inward/record.url?scp=79958239600&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79958239600&partnerID=8YFLogxK

U2 - 10.2215/CJN.09131010

DO - 10.2215/CJN.09131010

M3 - Article

VL - 6

SP - 1463

EP - 1473

JO - Clinical journal of the American Society of Nephrology : CJASN

JF - Clinical journal of the American Society of Nephrology : CJASN

SN - 1555-9041

IS - 6

ER -