Associations of body mass index and weight loss with mortality in transplant-waitlisted maintenance hemodialysis patients

M. Z. Molnar, E. Streja, C. P. Kovesdy, S. Bunnapradist, M. S. Sampaio, J. Jing, M. Krishnan, A. R. Nissenson, G. M. Danovitch, K. Kalantar-Zadeh

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106 Citations (Scopus)


A body mass index (BMI) below morbid obesity range is often a requirement for kidney transplant wait-listing, but data linking BMI changes to mortality during the waitlist period are lacking. By linking the 6-year (7/2001-6/2007) national databases of a large dialysis organization and the Scientific Registry of Transplant Recipients, we identified 14 632 waitlisted hemodialysis patients without kidney transplantation. Time-dependent survival models examined the mortality predictability of 13-week-averaged BMI, pretransplant serum creatinine as a muscle mass surrogate and their changes over time. The patients were on average 52 ± 13 years old, 40% women and had a BMI of 26.9 ± 6.3 kg/m2. Each kg/m2 increase of BMI was associated with a death hazard ratio (HR) of 0.96 (95%CI: 0.95-0.97). Compared to the lowest creatinine quintile, the 4th and 5th quintiles had death HRs of 0.75 (0.66-0.86) and 0.57 (0.49-0.66), respectively. Compared to minimal (< ± 1 kg) weight change over 6 months, those with 3 kg-<5 kg and ≥5 kg weight loss had death HRs of 1.31 (1.14-1.52) and 1.51 (1.30-1.75), respectively. Similar associations were observed with creatinine changes over time. Transplant-waitlisted hemodialysis patients with lower BMI or muscle mass and/or unintentional weight or muscle loss have higher mortality in this observational study. Impact of intentional weight change remains unclear.

Original languageEnglish
Pages (from-to)725-736
Number of pages12
JournalAmerican Journal of Transplantation
Issue number4
Publication statusPublished - Apr 1 2011



  • Dialysis
  • malnutrition-inflammation complex syndrome
  • muscle mass
  • obesity
  • survival
  • transplantation waiting list
  • weight loss

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

Cite this

Molnar, M. Z., Streja, E., Kovesdy, C. P., Bunnapradist, S., Sampaio, M. S., Jing, J., Krishnan, M., Nissenson, A. R., Danovitch, G. M., & Kalantar-Zadeh, K. (2011). Associations of body mass index and weight loss with mortality in transplant-waitlisted maintenance hemodialysis patients. American Journal of Transplantation, 11(4), 725-736.