ing/waitlist mortality, considering intentionality and frailty. Methods: We leveraged data on body mass index (BMI), weight loss intentionality, (one-year pre-evaluation and at evaluation), and frailty (four-component Physical Frailty Phenotype at evaluation) for 1,361 candidates (895 listed) with obesity (BMI≥30kg/m2) enrolled in a prospective multi-center cohort study. We estimated the association between pre-evaluation weight change (stable, gain, unintentional/intentional loss) with chance of listing/waitlist mortality using Cox proportional hazards/competing risk models. Results: Among candidates with obesity, 48% had stable weight, 17% had weight gain, 16% had unintentional weight loss, and 20% had intentional weight loss over the year prior to evaluation. Among frail candidates with obesity, stable weight was associated with 27% lower chance of listing (adjusted hazard ratio [aHR]:0.73,95% confidence intervals [CI]:0.55-0.96), weight gain with 47% lower chance of listing (aHR:0.53,95%CI:0.34-0.80), and unintentional weight loss with 48% lower chance of listing (aHR:0.52,95%CI:0.32-0.84) compared to non-frail candidates with stable weight. However, in frail candidates with obesity, intentional weight loss was not associated with a significantly lower chance of listing compared to non-frail candidates with stable weight. Additionally, among frail candidates with obesity, stable weight (adjusted sub-hazard ratio [aSHR]:1.72,95%CI:1.01-2.90), unintentional weight loss (aSHR:2.78,95%CI:1.23-6.27), and intentional weight loss (aSHR:2.26,95%CI:1.05-4.85) were associated with higher waitlist mortality compared to non-frail candidates with stable weight. Among non-frail candidates, no associations were observed for weight change and frailty status with either chance of listing or waitlist mortality. Conclusion: Among frail candidates with obesity, unintentional pre-KT weight loss is associated with lower chance of listing; however, any weight loss is associated with higher waitlist mortality. Our findings suggest that frail candidates with obesity may benefit from clinician supervision of pre-KT weight loss. Copyright © 2024 by the American Society of Nephrology...

中文翻译：

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减肥意向性和虚弱与肾移植前结果相关


ing/候补名单死亡率，考虑故意性和虚弱性。方法：我们利用了 1,361 名肥胖候选人 （BMI） 的体重指数 （BMI） 、减肥意向性（一年预评估和评估时）和虚弱（评估时的四分量身体虚弱表型）数据 （BMI≥30kg/m2） 参加一项前瞻性多中心队列研究。我们使用 Cox 比例风险/竞争风险模型估计了评估前体重变化 （稳定、增加、无意/故意损失） 与上市/候补名单死亡率之间的关联。结果： 在肥胖候选人中，48% 的体重稳定，17% 的体重增加，16% 的体重无意减轻，20% 的体重在评估前一年内有意减轻。在肥胖的虚弱候选人中，体重稳定与上市机会降低 27% 相关 （调整风险比 [aHR]：0.73,95% 置信区间 [CI]：0.55-0.96），体重增加与上市机会降低 47% 相关 （aHR： 0.53,95%CI：0.34-0.80），与体重稳定的非虚弱候选人相比，体重减轻与上市机会降低 48% 相关 （aHR： 0.52,95%CI：0.32-0.84）。然而，在肥胖的虚弱候选人中，与体重稳定的非虚弱候选人相比，故意减轻体重与上市机会显著降低无关。此外，在肥胖的虚弱候选人中，体重稳定 （调整后的次风险比 [aSHR]：1.72,95%CI：1.01-2.90）、意外体重减轻 （aSHR：2.78,95%CI：1.23-6.27） 和故意体重减轻 （aSHR： 2.26,95%CI：1.05-4.85） 与较高的候补名单死亡率相关与体重稳定的非虚弱候选人相比。 在非虚弱的候选人中，未观察到体重变化和虚弱状态与上市机会或候补名单死亡率的关联。结论：在虚弱的肥胖候选人中，无意的 KT 前体重减轻与上市机会较低相关;然而，任何体重减轻都与更高的候补名单死亡率相关。我们的研究结果表明，肥胖的虚弱候选人可能会受益于临床医生对 KT 前体重减轻的监督。美国肾脏病学会版权所有 © 2024...