Body Size and Outcomes in Dialysis and Transplant Patients - Does it Matter?

The terminologies of "body size", "body mass index (BMI)", "body weight", "large BMI" and "obesity" are controversial for defining the effects of "adiposity" or "fat excess" on the outcomes of dialysis and transplant patients. However, probably these terminologies will be continued to be used in the future as well, because of being older and simpler terminologies. In the general population obesity is a powerful risk factor for cardiovascular morbidity and mortality, while, it conferred a survival advantage to dialysis patients. However, this may be a oversimplification, since obesity may still be a risk factor in non-sarcopenic hemodialysis patients. Obesity is associated with early post-transplant adverse effects (i.e. delayed graft function, graft failure, wound infections, also transplant costs) and unfavorable graft and patient survival. However, thanks to safer immunosuppressive protocols, recently graft and patient survival is similar in obese as those of the non-obese patients. On the other hand, morbid obesity may still be a cause of unfavorable patient and graft survival. Since obese transplant recipients have better life expectancy as compared to wait-listed hemodialysis patients, they should be transplanted as well, while morbidly obese patients should be asked to lose weight before being placed in the waiting lists.