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Increasing Obesity and Diabetes Prevalence in the United States End-Stage Renal Disease Population

Shelton, Brittany1; McWilliams, Deanna M.1; MacLennan, Paul A.1; Reed, Rhiannon D.1; Mustian, Margaux N.1; Sawinski, Deirdre2; Locke, Jayme E.1

doi: 10.1097/01.tp.0000543382.36288.80
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Introduction Obesity and diabetes have both become national epidemics in the United States, and are associated with increased risk for comorbid diseases including end-stage renal disease (ESRD). Among ESRD patients, obesity may improve dialysis-survival but decreases likelihood of transplantation, and as such, obesity prevalence may directly impact growth of the incident dialysis population.

Materials and Methods Incident adult ESRD patients with complete body mass index (BMI, kg/m2) data were identified from the United States Renal Data System from 01/01/1995-12/31/2010 (n=1,822,598). Data from the Behavioral Risk Factor Surveillance System of the Centers for Disease Control and Prevention (n=4,303,471) represented the US population when weighted. Trends in BMI, obesity classes I (BMI of 30-34.9), II (BMI of 35-39.9), and diabetes prevalence were examined by year of dialysis initiation. Trends in mean BMI slope and diabetes prevalence were compared between the ESRD and US populations using linear regression.

Results and Discussion Median BMI of ESRD patients in 1995 was 25.2 as compared to 29.4 in 2010, a 16.7% increase, while the US population’s mean BMI increased from 25.3 in 1995 to 27.2 in 2010, a 7.5% increase. Comparable trends were noted with respect to prevalence of obesity classes I and II. Diabetes prevalence increased from 43% in 1995 to 55% in 2012, a 27.9% increase (Table). BMI increase among the ESRD population was significantly more rapid than among the US population (β: 0.15, 95% CI: 0.14-0.17, p<0.001) as was the increase of diabetes prevalence (β: 0.40, 95% CI: 0.29-0.50, p<0.001) (Figure).

Conclusion The mean BMI of ESRD patients and the prevalence of diabetes among the ESRD population are increasing more rapidly than the US population. Given decreased access to kidney transplantation among obese ESRD patients, future research should be directed at controlling healthcare expenditures by identifying strategies to address the growing obesity epidemic in the United States

1Surgery, University of Alabama at Birmingham, Birmingham, AL, United States;

2Medicine, University of Pennsylvania, Philadelphia, PA, United States.

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