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This manuscript was modified from a previous guideline written by Christian van Delden and Emily Blumberg published in the American Journal of Transplantation 2009; 9(Suppl 4): S27�CS34, and endorsed by American Society of Transplantation/Canadian Society of Transplantation. The authors of this manuscript have conflicts of interest to disclose as described by the American Journal of Transplantation. Dr. van Duin was a DSMB for Pfizer and a member of the speakers bureau for Astellas. ""A body mass index (BMI) below morbid obesity range is often a requirement for kidney transplant wait-listing, but data linking BMI changes to mortality during the waitlist period are lacking. By linking the 6-year (7/2001�C6/2007) national databases of a large dialysis organization and the Scientific Registry of Transplant Recipients, we identified 14 632 waitlisted hemodialysis patients without kidney transplantation. http://www.selleckchem.com/products/cb-839.html Time-dependent survival models examined the mortality predictability of 13-week-averaged BMI, pretransplant serum creatinine http://www.selleckchem.com/products/BI6727-Volasertib.html as a muscle mass surrogate and their changes over time. The patients were on average 52 �� 13 years old, 40% women and had a BMI of 26.9 �� 6.3 kg/m2. Each kg/m2 increase of BMI was associated with a death hazard ratio (HR) of 0.96 (95%CI: 0.95�C0.97). Compared to the lowest creatinine quintile, the 4th and 5th quintiles had death HRs of 0.75 (0.66�C0.86) and 0.57 (0.49�C0.66), respectively. Compared to minimal ( http://www.selleck.cn/products/wnt-c59-c59.html hemodialysis patients with lower BMI or muscle mass and/or unintentional weight or muscle loss have higher mortality in this observational study. Impact of intentional weight change remains unclear. Kidney transplantation is the treatment of choice in patients with end-stage renal disease (ESRD), since patients with functioning renal grafts have both survival benefits (1) and better quality of life (2) compared to transplant-waitlisted patients on maintenance dialysis. Approximately 80 000 (20%) of the 400 000 U.S. dialysis patients are currently on transplantation waiting lists, although each year only 16 500 of these patients receive a renal transplant (3,4). At least half of these patients receive a deceased kidney, which currently requires a wait period of 3�C6 years in most regions of the United States (3). During this period, up to 40% of the transplant-waitlisted dialysis patients die (5). Hence, identifying the modifiable risk factors of poor survival during the waitlist period is of immense importance.