Metabolisches Syndrom und Adipositas bei Nierentransplantation

Background: Obesity and the metabolic syndrome (MS) are risk factors for chronic kidney disease (CKD) and are associated with challenges before, during and after kidney transplantation. Objective: The significance of obesity and the MS in CKD and recommendations for the management at various stages of kidney transplantation. Material and methods: Search of the literature and screening of selected guidelines on kidney transplantation. Results: Although the negative impact of obesity and MS on the outcome of kidney transplantation is well known, there are few specific recommendations in the current guidelines. The lack of comparative studies and meta-analyses on the best risk stratification of obesity in the context of CKD as well as the inconsistent definition of the MS, complicate the ability to draw conclusions. Conclusion: The body mass index (BMI) serves as a measure of obesity in all guidelines, although its validity is controversial. The standardized collation of measures of central obesity, weight reduction through multidisciplinary programs and accurate screening of obesity-associated cardiovascular risk factors before transplantation appear to be meaningful. Consideration of bariatric interventions is recommended only on a case by case basis and with a careful risk-benefit analysis. The effects of immunosuppressive agents on absorption should particularly be considered.