Pre-kidney transplant unintentional weight loss leads to worse post-kidney transplant outcomes. Issue 10 (25th April 2021)

• Record Type: Journal Article
• Authors: Harhay, Meera N; Chen, Xiaomeng; Chu, Nadia M; Norman, Silas P; Segev, Dorry L; McAdams-DeMarco, Mara
• Is Part Of: Nephrology dialysis transplantation. Volume 36:Issue 10(2021)
• Page Start: 1927
• Page End: 1936
• Publication Date: 2021-04-25
• Subjects: kidney transplant -- obesity -- weight loss; Nephrology -- Periodicals; Hemodialysis -- Periodicals; Kidneys -- Transplantation -- Periodicals; Hemodialysis; Kidneys -- Transplantation; Nephrology; Periodicals; 616.61
• DOI: 10.1093/ndt/gfab164
• Languages: English
• ISSNs: 0931-0509

Abstract

Abstract: Background: Weight loss before kidney transplant (KT) is a known risk factor for weight gain and mortality, however, while unintentional weight loss is a marker of vulnerability, intentional weight loss might improve health. We tested whether pre-KT unintentional and intentional weight loss have differing associations with post-KT weight gain, graft loss and mortality. Methods: Among 919 KT recipients from a prospective cohort study, we used adjusted mixed-effects models to estimate post-KT BMI trajectories, and Cox models to estimate death-uncensored graft loss, death-censored graft loss and all-cause mortality by 1-year pre-KT weight change category [stable weight (change ≤ 5%), intentional weight loss (loss > 5%), unintentional weight loss (loss > 5%) and weight gain (gain > 5%)]. Results: The mean age was 53 years, 38% were Black and 40% were female. In the pre-KT year, 62% of recipients had stable weight, 15% had weight gain, 14% had unintentional weight loss and 10% had intentional weight loss. In the first 3 years post-KT, BMI increases were similar among those with pre-KT weight gain and intentional weight loss and lower compared with those with unintentional weight loss {difference +0.79 kg/m 2 /year [95% confidence interval (CI) 0.50–1.08], P < 0.001}. Only unintentional weight loss was independently associated with higher death-uncensored graft loss [adjusted hazard ratio (aHR) 1.80 (95% CI 1.23–2.62)], death-censored graft loss [aHR 1.91 (95% CI 1.12–3.26)] and mortality [aHR 1.72 (95% CI 1.06–2.79)] relative to stable pre-KT weight. Conclusions: This study suggests that unintentional, but not intentional, pre-KT weight loss is an independent risk factor for adverse post-KT outcomes. GRAPHICAL ABSTRACT: