Obesity After Kidney Transplantation—Results of a KTx360°Substudy

Abstract

Objective: There is solid evidence that kidney transplant (KTx) patients are susceptible to weight gain after transplantation. Post-transplantation obesity [body mass index (BMI) ≥ 30 kg/m 2 ] seems to be associated with higher risks of hypertension, dyslipidemia, diabetes mellitus, and cardiovascular events, while there are contradicting findings regarding the association between obesity and mortality, graft failure after transplantation as well as other variables. We aimed to evaluate the course of weight after KTx and to assess the prevalence of post-transplant obesity in a large sample of German KTx patients. Further, we focused on potential associations between weight gain, obesity, and BMI after transplantation with sociodemographic, medical, psychological [levels of anxiety and depression measured with the Hospital Anxiety and Depression Scale (HADS)], and donation-specific variables. Methods: In a structured post-transplant care program 433 KTx patients were evaluated at Hannover Medical School. Information on the pre-transplant body weight/dry weight of dialysis patients was taken from the electronic patient charts. At post-transplant assessment body weight was measured in the transplant center. For statistical analyses, descriptive statistics, analyses of variance, tests for correlations, and regression analyses were used. Results: Mean age was 51.3 years, 59% were male and 26.3% had ≥12 years of school attendance. Regarding somatic conditions 6.0% were suffering from type 2 diabetes mellitus, 6.9% were affected by new-onset diabetes after transplantation (NODAT), and the mean estimated glomerular filtration rate (eGFR) was 47.7 ml/min/1.73m 2. The prevalence rates of obesity before and after kidney transplantation were 14.8 and 19.9%, respectively. This represents an increase of 34%. Obesity after transplantation was associated with higher rates of type 2 diabetes mellitus and of NODAT. Additionally, there was an association between increasing pre-transplant as well as post-transplant BMI and decreasing eGFR. Higher age and female sex were associated with higher rates of post-transplant obesity.

Associations between Depression, Nutritional Status and Mediterranean Diet in Dalmatian Kidney Transplant Recipients

“…The positive associations between BDI-II scores and BMI found in our study are opposite to the results from Nohre et al who found no association between BMI and depression in KTRs [34]. A possible explanation for our finding is that the higher BMI in our study population reflects the higher content of fat mass.…”

Blood Pressure Treatment in Kidney Transplant Recipients—Can We Improve?

“…A recently published German study (KTx360°) evaluated pre- and post-KTx BMI in 433 recipients. 29 In the present study, 23% versus 19% had a BMI >30 kg/m 2 in the “above-target” and “on-target” groups, respectively ( P = 0.014). Nonpharmacologic interventions such as diet, exercise, and weight reduction (if warranted) should always be part of posttransplant hypertension treatment.…”

Weight gain after renal transplant: Incidence, risk factors, and outcomes

“…The data on the association between new-onset diabetes post kidney transplantation (NODAT) and weight gain are controversial. A meta-analysis study, done in 2018 to check the correlation between NODAT and increasing BMI post-transplant, showed that increased BMI is an independent risk of having NODAT [ 26 ]. Furthermore, a recent study, done in 2020, showed that post-transplant obesity was associated with a higher rate of type 2 DM and NODAT [ 27 ].…”