title: Differential association of body mass index with access to kidney transplantation in men and women.
abstract: OBJECTIVE
  Obese patients encounter barriers to medical care not encountered by lean patients, and inequities in access to care among obese patients may vary by sex. This study aimed to determine the association of body mass index (BMI) with access to kidney transplantation in men and women.
  
  
  METHODS
  In this retrospective analysis of 702,456 incident ESRD patients aged 18-70 years (captured in the US Renal Data System between 1995 and 2007), multivariate time-to-event analyses were used to determine the association of BMI with likelihood of transplantation from any donor source, transplantation from a living donor, and transplantation from a deceased donor, as well the individual steps in obtaining a deceased donor transplant (activation to the waiting list, and transplantation after wait-listing).
  
  
  RESULTS
  Among women, a BMI ≥ 25.0 kg/m(2) was associated with a lower likelihood of transplantation from any donor source (hazard ratio [HR], 0.75; 95% confidence interval [95% CI], 0.73 to 0.77), transplantation from a living donor (HR, 0.75; 95% CI, 0.72 to 0.77), and transplantation from a deceased donor (HR, 0.74; 95% CI, 0.72 to 0.77). By contrast, among men, a BMI of 25.0-34.9 kg/m(2) was associated with a higher likelihood of the outcomes of transplantation from any donor source (HR, 1.08; 95% CI, 1.06 to 1.11), transplantation from a living donor (HR, 1.18; 95% CI, 1.13 to 1.22), and transplantation from a deceased donor (HR, 1.05; 95% CI, 1.02 to 1.07). Among men, the level beyond which BMI was associated with a lower likelihood of transplantation from any donor source or a living donor was ≥ 40.0 kg/m(2), and ≥ 35.0 kg/m(2) in the case of deceased donor transplantation.
  
  
  CONCLUSIONS
  The association of BMI with access to transplantation varies between men and women. The reasons for this difference should be further studied.
authors.affiliation: Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada;, †Center for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada, ‡Tufts-New England Medical Center, Boston, Massachusetts.
authors.forename: John S
authors.initials: JS
authors.lastname: Gill
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Hendren
authors.forename: Jianghu
authors.initials: J
authors.lastname: Dong
authors.forename: Olwyn
authors.initials: O
authors.lastname: Johnston
authors.forename: Jagbir
authors.initials: J
authors.lastname: Gill
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery*; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D019520:Living Donors / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D012189:Retrospective Studies; D012737:Sex Factors; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data*; D014481:United States; D014850:Waiting Lists; D055815:Young Adult
keywords: epidemiology; kidney transplantation; obesity; outcomes
references.citation: JAMA. 2008 Jan 9;299(2):202-7
references.pmid: 18182602
references.citation: Clin J Am Soc Nephrol. 2011 Jun;6(6):1463-73
references.pmid: 21415312
references.citation: CMAJ. 2005 Nov 8;173(10):1181-4
references.pmid: 16275969
references.citation: J Am Soc Nephrol. 2013 Nov;24(11):1872-9
references.pmid: 23990679
references.citation: J Rural Health. 2012 Fall;28(4):392-7
references.pmid: 23083085
references.citation: Transplantation. 2012 Sep 15;94(5):513-9
references.pmid: 22895611
references.citation: Obesity (Silver Spring). 2012 Aug;20(8):1639-44
references.pmid: 21818146
references.citation: Kidney Int. 2011 Jul;80(2):218-24
references.pmid: 21525853
references.citation: J Womens Health Gend Based Med. 2001 Jun;10(5):463-70
references.pmid: 11445045
references.citation: JAMA. 1998 Oct 7;280(13):1148-52
references.pmid: 9777814
references.citation: JAMA. 2010 Jan 20;303(3):235-41
references.pmid: 20071471
references.citation: Transplant Proc. 2012 Nov;44(9):2787-91
references.pmid: 23146525
references.citation: JAMA. 2009 Apr 22;301(16):1681-90
references.pmid: 19383959
references.citation: Health Econ. 2013 Sep;22(9):1093-110
references.pmid: 23494838
references.citation: J Clin Epidemiol. 2008 Jul;61(7):646-53
references.pmid: 18359190
references.citation: Ann Intern Med. 2000 May 2;132(9):697-704
references.pmid: 10787362
references.citation: Am J Kidney Dis. 1997 Dec;30(6):733-8
references.pmid: 9398115
references.citation: J Am Soc Nephrol. 1996 Aug;7(8):1139-44
references.pmid: 8866404
references.citation: Am J Transplant. 2013 Aug;13(8):2083-90
references.pmid: 23890325
references.citation: Arch Intern Med. 2000 Aug 14-28;160(15):2349-54
references.pmid: 10927733
references.citation: Ann Surg. 2013 Nov;258(5):722-30
references.pmid: 24096768
references.citation: Am J Kidney Dis. 2000 Nov;36(5):1025-33
references.pmid: 11054361
references.citation: Am J Transplant. 2012 Dec;12(12):3283-8
references.pmid: 23016838
references.citation: J Surg Res. 2012 Apr;173(2):216-23
references.pmid: 21816424
references.citation: J Am Soc Nephrol. 2008 Feb;19(2):349-55
references.pmid: 18094366
references.citation: Lancet. 2005 Nov 5;366(9497):1640-9
references.pmid: 16271645
references.citation: J Am Coll Cardiol. 2011 May 10;57(19):1877-86
references.pmid: 21545944
references.citation: Am J Manag Care. 2012 Jan;18(1):25-32
references.pmid: 22435746
references.citation: J Obes. 2011;2011:218250
references.pmid: 22220270
references.citation: Am J Transplant. 2003 Feb;3(2):178-85
references.pmid: 12603213
references.citation: Obes Rev. 2011 Sep;12(9):680-7
references.pmid: 21521449
references.citation: J Am Coll Cardiol. 2009 Apr 14;53(15):1265-72
references.pmid: 19358939