Before this talk, I knew little information about kidney disease and transplantation. I was surprised that American Indians/Alaska Natives are 9.5 times greater to get kidney disease than Caucasians. It was also surprising to find out that 38% of transplant candidates meet the criteria for obesity and that obesity can prevent someone from getting a kidney transplant. I liked how both studies dealt with attitudes toward BMI and and eligibility for transplantation. The premise of study 1 was very interesting to me and it was shocking that 80% of providers thought that it was okay to transplant someone with a BMI between 30 and 35. In my personal opinion, I think that it is okay to transplant someone with a BMI between 30 and 35 as long as they are educated on the risks and possible outcomes of the transplant. In study 2, the purpose was to explore the role of BMI in determining patient eligibility for kidney transplantation. 5 programs identified a maximum BMI as a absolute contraindication and 9 programs identified it as a relative contraindication. Overall, the main limitation from these 2 studies is that it is mainly an opinion based study, the questions asked to providers could be based on their own personal opinion rather than policy. What fascinated me the most was that weight loss prior to transplant has not been shown to improve outcomes, which is ironic because providers urge people to lose weight to become eligible for a transplant, but the outcome is not improved. I also feel as though providers should run more tests to see if an individual is eligible for a transplant rather than just judging off of their BMI.
I agree with your statement about how prior weight loss doesn’t improve outcomes. It is interesting to see how what a patient may work for in order to lose weight may not mean as much as we thought if they’re outcomes don’t really change. I wonder why.
What we talked about in lab today is the eligibility criteria for patients to get on a kidney transplant list. We learned that it’s not just BMI that they use to judge whether they’re eligible. Rather it’s a very holistic overview. The patient may have to get bloodwork down to identify other possible conditions, get a psychological evaluation to make sure that conditions such as depression are treated, and discuss their social network and financial status to their doctor to ensure that they have support that is needed and that they can afford to be on the necessary drugs post-transplant. The speaker didn’t really talk about the other criteria but I think it’s really important to note this because it makes so much more sense versus just using BMI.
Maya – I also did not know much about this topic before Dr. Gardiner’s talk. I was shocked to learn how much more common it is for American Indians/Alaska Natives to contract kidney disease, compared to Caucasians. This was especially surprising because Caucasians are the highest in number on the waiting lists for these transplants. I agree with you that it is okay to transplant somebody with a BMI between 30 and 35 if they are aware of the risks, and in my opinion, this should be a personal decision anyway. If a person is informed and knows all the possibilities, they should be able to do what they want with their body. I certainly think providers should base eligibility for transplants on more than just BMI as well. I thought it was interesting when Dr. Gardiner brought up all the different types of ways that exist to measure weight, without needing to use BMI. Although I thought her talk was definitely thought-provoking, I also noticed that this was mainly an opinion-based study, and I do wish some of the questions providers were asked could have been more focused on policy.
I think you have a lot of really informed opinions in this post. And its really unnerving how much patient treatment isn’t based off policy or research but instead people’s opinions and old data. Hopefully in a field so based and dependent on current research, the policies will be updated to have the patients best interests in mind.