PracticeUpdate Conference Series ISN WCN 2019

Weight Gain and Obesity Post-Kidney Transplant Alarmingly High in Pediatric Population Strategies to prevent excessive weight gain are sorely needed in this population.

A s many as half of children who undergo kidney transplantation are overweight or obese 1 year later, according to an analysis presented at WCN 2019. Independent predictors of weight gain were found to be body mass index (BMI) at the time of transplantation and during time on dialysis. The data were presented by Sean Kennedy, MD, of Sydney Children's Hospital in Randwick, New South Wales. Dr. Kennedy and his colleagues per- formed a single-center, retrospective analysis of 55 kidney transplants per- formed in 53 recipients between January 2000 and July 2017. All recipients were 18 years of age or younger, and their median age at the time of transplantation was 10 years (interquartile range 7.06–15.13). The primary outcome was the change in BMI Z-score at 12 months, with a secondary outcome at 24 months. Weight and height data were recorded at transplantation, monthly until 6 months, every 3 months thereafter until 12 months, and then every 6 months until 24 months. The prevalence of overweight and obesity increased from 24% and 9% at transplanta- tion to 26% and 24% at 12months, and 32% and 26% at 24 months, respectively. The mean change in BMI Z-score rose signifi- cantly from 0.60 (95% confidence interval 0.27–0.93) at transplantation to 1.29 (95% CI 0.98–1.60) at 12 months and 1.49 (95% CI 1.14–1.83) at 24 months. Multivariate analysis revealed that BMI-Z at transplant (P < .001) as well as >12 months spent on dialysis (P = .006) were " It is striking that this many patients became obese. It is greater than that seen in the adult population. "

both significant predictors of change in BMI Z-score at 12 months and 24 months post-transplantion (P < .001 and P = .034, respectively). No other patient- or treat- ment-related variables, including age, gender, ethnicity, primary disease etiology, gastrostomy prevalence, supplementary feeding, or cumulative prednisolone dose between time of transplantation and 3 months afterwards, were found to significantly predict weight gain in an independent fashion. In a comment on the study for Elsevier’s PracticeUpdate , session moderator Toby Coates, MD, of the University of Adelaide, South Australia, noted that the

high proportion of patients who were overweight and obese in this population is “alarming.” Such substantial weight gain places these patients at higher risk of type 2 diabetes which, in turn, places additional strain on the kidneys. “Obesity is bad on many fronts,” Dr. Coates said. “It is striking that this many patients became obese. It is greater than that seen in the adult population.” There is an important unanswered ques- tion, he added: “What strategies can be developed to prevent weight gain, includ- ing non-drug strategies?”

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WCN 2019 • PRACTICEUPDATE CONFERENCE SERIES