Heather Gardiner discussed the issues of using BMI to determine eligibility for a kidney transplant. There are many issues using BMI, as it does not take into account muscle mass. As well as, does not take into account gender and age. Many individuals who have high BMI’s are obese and later suffer from kidney disease. Chronic kidney disease can be dormant until it reaches end-stage renal disease. 703,000 individuals suffer from ESRD, and minorities are more affected due to high rates of diabetes and hypertension in a lot of their communities. Once a patient is diagnosed with ESRD, they are put on dialysis in hopes of one day receiving a kidney transplant. Majority of the individuals on the waitlist for a transplant are minorities, but whites receive most of the transplants. There is conflicting evidence regarding obesity and kidney transplantation. Many centers encourage weight loss before receiving a kidney transplant, but evidence shows it is good to be a little overweight in the long run when having received a transplant. While other evidence shows, obesity negative effects the ability to perform a kidney transplantation and has lower success rates in the short term. Many centers/programs have their own criteria for eligibility for a kidney transplant, which mainly uses BMI and other factors. To get a better understanding of how healthcare professionals view these policies, Gardiner and peers performed a study. The study looked at how these individuals viewed the policies, and whether they agreed with the policy or were even aware there was a policy. Gardiner also asked what the cutoff for kidney transplant should be in regards to BMI. Gardiner then performed another study to view the criteria from kidney transplant centers. She was only able to receive 19, as she found that centers were not very willing to hand over this information. Information that should be easily accessible to potential patients. Many centers had cutoffs for eligibility that were in terms BMI levels. She found that this is an issue because many individuals can not lose the weight required when on dialysis and that many of the programs don’t offer any assistance in achieving the weight loss required. As well as, the increasing difficulty to get put back on the waitlist, once made inactive by the center. She proposed many recommendations on how to better the system, but we need to assess provider/program bias (implicit and explicit). Weight loss prior to transplant has not been shown to improve transplant outcome. As well as, using different measurements instead of BMI that differentiate muscle mass and adiposity.
I found the talk very interesting, as I did not have much knowledge of the process of kidney transplantation or what goes into being eligible for a kidney transplant. Unsurprisingly, I was not shocked that minority groups as the ones who suffer most when discussing these issues. While I personally do not know anyone who is on dialysis or needs a kidney transplant, it was still sad to hear all the issues of using BMI to determine eligibility. If we know using BMI is not a good indicator, why do we continue to use it and not adopt some of the alternatives? Why do we use hemodialysis most often in the US, when peritoneal dialysis is proven to be better? The talk overall was very interesting, and I thought she presented the information clearly and made it thought provoking.
I was also taken back by the fact that hemodialysis is used most often when peritoneal dialysis is proven to be better. I think this just goes along with the fact that healthcare providers do not always diagnose/treat patients with the latest studies in mind. This is especially true with the use of BMI as an indicator. The underlying politics of the healthcare system, mostly who can benefit from doing what, controls a lot of the issues, as disheartening as this may be.
In reading your post at first, I thought you were just going to regurgitate all that we learned during Dr. Gardiner’s talk, but as I read further, you finally got going. I agree that we have all of these alternatives yet we stick with hemodialysis, but you know what the reason is, man–money. Needing constant support feeds our healthcare system’s wallet. Now, why they choose to bankrupt the less financially affluent (i.e. minorities)? Well, that is when you get into racial inequality and inequity. Even though people try to avoid talking about race now a days, or say that it doesn’t make a difference, especially in something related to healthcare, I pity he who chooses to remain ignorant when evidence of disparities are presented to him point blank.