Skip to main content

Metabolisches Syndrom und Adipositas bei Nierentransplantation

Metabolic syndrome and obesity in kidney transplantation

Zusammenfassung

Hintergrund

Adipositas und das metabolische Syndrom (MS) sind Risikofaktoren für die chronische Nierenerkrankung („chronic kidney disease“, CKD) und mit Herausforderungen vor, während und nach der Nierentransplantation (NTx) verbunden.

Fragestellung

Bedeutung der Adipositas und des MS für die CKD und Empfehlungen zum Management in den verschiedenen Phasen der NTx.

Material und Methode

Recherche von Literatur und Screening ausgewählter Leitlinien zur NTx.

Ergebnisse

Obwohl die negativen Auswirkungen der Adipositas und des MS auf das Outcome nach NTx bekannt sind, gibt es nur wenig konkrete Empfehlungen in den aktuellen Leitlinien. Fehlende vergleichende Studien und Metaanalysen zur besten Risikostratifizierung der Adipositas im Rahmen der CKD sowie die uneinheitliche Definition des MS erschweren die Aussagemöglichkeiten.

Schlussfolgerungen

Der Body-Mass-Index dient in allen Leitlinien als Maßzahl der Adipositas, obwohl seine Aussagekraft umstritten ist. Die standardisierte Erhebung von Maßzahlen der zentralen Adipositas, die Gewichtsreduktion durch multidisziplinäre Programme und genaues Screening adipositasassoziierter kardiovaskulärer Risikofaktoren vor Transplantation erscheinen sinnvoll. Die Erwägung bariatrischer Interventionen wird nur im Einzelfall und unter sorgfältiger Risiko-Nutzen-Analyse empfohlen. Insbesondere die Effekte auf die Resorption der immunsuppressiven Therapie sollten bedacht werden.

Abstract

Background

Obesity and the metabolic syndrome (MS) are risk factors for chronic kidney disease (CKD) and are associated with challenges before, during and after kidney transplantation.

Objective

The significance of obesity and the MS in CKD and recommendations for the management at various stages of kidney transplantation.

Material and methods

Search of the literature and screening of selected guidelines on kidney transplantation.

Results

Although the negative impact of obesity and MS on the outcome of kidney transplantation is well known, there are few specific recommendations in the current guidelines. The lack of comparative studies and meta-analyses on the best risk stratification of obesity in the context of CKD as well as the inconsistent definition of the MS, complicate the ability to draw conclusions.

Conclusion

The body mass index (BMI) serves as a measure of obesity in all guidelines, although its validity is controversial. The standardized collation of measures of central obesity, weight reduction through multidisciplinary programs and accurate screening of obesity-associated cardiovascular risk factors before transplantation appear to be meaningful. Consideration of bariatric interventions is recommended only on a case by case basis and with a careful risk-benefit analysis. The effects of immunosuppressive agents on absorption should particularly be considered.

This is a preview of subscription content, access via your institution.

Literatur

  1. Abramowicz D, Cochat P, Claas FH et al (2015) European renal best practice guideline on kidney donor and recipient evaluation and perioperative care. Nephrol Dial Transplant 30:1790–1797

    Article  Google Scholar 

  2. Arbeitsgemeinschaft Der Nierentransplantationszentren Nordrhein-Westfalens (2021) MANUAL zur Vereinheitlichung der Evaluation vor Nierentransplantation und Nierenlebendspende, der Wartelistenführung vor Nierentransplantation und zur Nachsorge nach Nierentransplantation und Nierenlebendspende

    Google Scholar 

  3. Campbell S, Pilmore H, Gracey D et al (2013) KHA-CARI guideline: recipient assessment for transplantation. Nephrology (Carlton) 18:455–462

    Article  Google Scholar 

  4. Chadban SJ, Ahn C, Axelrod DA et al (2020) KDIGO clinical practice guideline on the evaluation and management of candidates for kidney transplantation. Transplantation 104:S11–S103

    Article  Google Scholar 

  5. D’Agati VD, Chagnac A, de Vries AP et al (2016) Obesity-related glomerulopathy: clinical and pathologic characteristics and pathogenesis. Nat Rev Nephrol 12:453–471

    Article  Google Scholar 

  6. Dudley C, Harden P (2011) Renal association clinical practice guideline on the assessment of the potential kidney transplant recipient. Nephron Clin Pract 118(1):c209–224

    Article  Google Scholar 

  7. Friedman AN, Miskulin DC, Rosenberg IH et al (2003) Demographics and trends in overweight and obesity in patients at time of kidney transplantation. Am J Kidney Dis 41:480–487

    Article  Google Scholar 

  8. Garofalo C, Borrelli S, Minutolo R et al (2017) A systematic review and meta-analysis suggests obesity predicts onset of chronic kidney disease in the general population. Kidney Int 91:1224–1235

    Article  Google Scholar 

  9. Gill JS, Lan J, Dong J et al (2013) The survival benefit of kidney transplantation in obese patients. Am J Transplant 13:2083–2090

    CAS  Article  Google Scholar 

  10. Hoogeveen EK, Aalten J, Rothman KJ et al (2011) Effect of obesity on the outcome of kidney transplantation: a 20-year follow-up. Transplantation 91:869–874

    Article  Google Scholar 

  11. International Diabetes Federation (2006) The IDF consensus worldwide definition of the metabolic syndrome

    Google Scholar 

  12. Kasiske BL, Cangro CB, Hariharan S et al (2001) The evaluation of renal transplantation candidates: clinical practice guidelines. Am J Transplant 1(2):3–95

    PubMed  Google Scholar 

  13. Knoll G, Cockfield S, Blydt-Hansen T et al (2005) Canadian society of transplantation consensus guidelines on eligibility for kidney transplantation. Cmaj 173:1181–1184

    Article  Google Scholar 

  14. Kopple JD, Zhu X, Lew NL et al (1999) Body weight-for-height relationships predict mortality in maintenance hemodialysis patients. Kidney Int 56:1136–1148

    CAS  Article  Google Scholar 

  15. Kotsis V, Martinez F, Trakatelli C et al (2021) Impact of obesity in kidney diseases. Nutrients 13(12):4482

    CAS  Article  Google Scholar 

  16. Krishnan N, Higgins R, Short A et al (2015) Kidney transplantation significantly improves patient and graft survival irrespective of BMI: a cohort study. Am J Transplant 15:2378–2386

    CAS  Article  Google Scholar 

  17. Kurella M, Lo JC, Chertow GM (2005) Metabolic syndrome and the risk for chronic kidney disease among nondiabetic adults. J Am Soc Nephrol 16:2134–2140

    Article  Google Scholar 

  18. Ladhani M, Craig JC, Irving M et al (2017) Obesity and the risk of cardiovascular and all-cause mortality in chronic kidney disease: a systematic review and meta-analysis. Nephrol Dial Transplant 32:439–449

    CAS  PubMed  Google Scholar 

  19. Laguardia H, Zhang R (2013) Obesity and metabolic syndrome in kidney transplantation. Curr Hypertens Rep 15:215–223

    CAS  Article  Google Scholar 

  20. Leavey SF, Mccullough K, Hecking E et al (2001) Body mass index and mortality in ‘healthier’ as compared with ‘sicker’ haemodialysis patients: results from the dialysis outcomes and practice patterns study (DOPPS). Nephrol Dial Transplant 16:2386–2394

    CAS  Article  Google Scholar 

  21. Meier-Kriesche HU, Arndorfer JA, Kaplan B (2002) The impact of body mass index on renal transplant outcomes: a significant independent risk factor for graft failure and patient death. Transplantation 73:70–74

    Article  Google Scholar 

  22. Molnar MZ, Kovesdy CP, Mucsi I et al (2011) Higher recipient body mass index is associated with post-transplant delayed kidney graft function. Kidney Int 80:218–224

    Article  Google Scholar 

  23. O’brien R, Johnson E, Haneuse S et al (2018) Microvascular outcomes in patients with diabetes after bariatric surgery versus usual care: a matched cohort study. Ann Intern Med 169:300–310

    Article  Google Scholar 

  24. Oniscu GC, Abramowicz D, Bolignano D et al (2021) Management of obesity in kidney transplant candidates and recipients: a clinical practice guideline by the DESCARTES working group of ERA. Nephrol Dial Transplant 37:i1–i15

    Article  Google Scholar 

  25. Panwar B, Hanks LJ, Tanner RM et al (2015) Obesity, metabolic health, and the risk of end-stage renal disease. Kidney Int 87:1216–1222

    Article  Google Scholar 

  26. Pham PT, Pham PM, Pham SV et al (2011) New onset diabetes after transplantation (NODAT): an overview. Diabetes Metab Syndr Obes 4:175–186

    Article  Google Scholar 

  27. Rashidbeygi E, Safabakhsh M, Delshad Aghdam S et al (2019) Metabolic syndrome and its components are related to a higher risk for albuminuria and proteinuria: evidence from a meta-analysis on 10,603,067 subjects from 57 studies. Diabetes Metab Syndr 13:830–843

    Article  Google Scholar 

  28. Singh A, Sarkar SR, Gaber LW et al (2007) Acute oxalate nephropathy associated with orlistat, a gastrointestinal lipase inhibitor. Am J Kidney Dis 49:153–157

    CAS  Article  Google Scholar 

  29. Stengel B, Tarver-Carr ME, Powe NR et al (2003) Lifestyle factors, obesity and the risk of chronic kidney disease. Epidemiology 14:479–487

    PubMed  Google Scholar 

  30. WHO (2021) Obesity and overweight. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Zugegriffen: 8. März 2022

  31. Woloszyk P, Malgorzewicz S, Chamienia A et al (2020) Obesity after successful kidney transplantation. Transplant Proc 52:2352–2356

    Article  Google Scholar 

  32. Ying T, Shi B, Kelly PJ et al (2020) Death after kidney transplantation: an analysis by era and time post-transplant. J Am Soc Nephrol 31:2887–2899

    CAS  Article  Google Scholar 

  33. Yusuf S, Hawken S, Ounpuu S et al (2004) Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 364:937–952

    Article  Google Scholar 

  34. Zhang X, Lerman LO (2017) The metabolic syndrome and chronic kidney disease. Transl Res 183:14–25

    CAS  Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to L. Platen.

Ethics declarations

Interessenkonflikt

L. Platen, V. Kappler, F. Schraml, C. Holzmann-Littig und L. Renders geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

Redaktion

Uwe Heemann, München

Jens Lutz, Koblenz

figure qr

QR-Code scannen & Beitrag online lesen

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Platen, L., Kappler, V., Schraml, F. et al. Metabolisches Syndrom und Adipositas bei Nierentransplantation. Nephrologie 17, 312–318 (2022). https://doi.org/10.1007/s11560-022-00589-4

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11560-022-00589-4

Schlüsselwörter

  • Chronische Nierenerkrankung
  • Nierentransplantation
  • Kardiovaskuläre Risikofaktoren
  • Body-Mass-Index
  • Gewichtsreduktion

Keywords

  • Chronic renal insufficiency
  • Kidney transplantation
  • Cardiovascular risk factors
  • Body mass index
  • Weight loss