Are Females More Prone Than Males to Become Obese After Kidney Transplantation?

Investigation of Weight Gain and Affecting Factors in Kidney Transplant Recipients in the First 2 Years After Transplant

OBJECTIVES

It is necessary to examine weight gain and affecting factors after kidney transplant. This study was performed to examine weight gain and affecting factors in kidney transplant recipients in the first 2 years after transplant.

MATERIALS AND METHODS

This descriptive cross-sectional study included 139 kidney transplant recipients who were regularly followed by 2 university hospitals in the first 2 years after transplant. Data were collected with the use of a sociodemographic and clinical features' form and the General Self-Efficacy Scale. Weight and body mass index at 3, 6, 12, and 24 months after transplant were evaluated. Differences between weight (in kilograms) and body mass index (in kilograms divided by height in meters squared) at the first outpatient clinic visit and weight and body mass index at 24 months after transplant were calculated.

RESULTS

The mean age of patients was 46.32 ± 12.39 years. Differences in mean weight and body mass index between the first posttransplant outpatient clinic visit and at month 24 posttransplant were 7.07 ± 7.57 and 2.6 ± 2.37, respectively. Statistically significant differences were found in weight and body mass index at 2 years posttransplant. As age increased, weight gain decreased. Differences in weight gain and body mass index were not significantly associated with sex, presence of chronic diseases, donor type, steroid dose, and self-efficacy.

CONCLUSIONS

Kidney transplant recipients in our study population had increased weight and body mass index at 2 years after transplant. Younger kidney transplant recipients had higher weight gains. Therefore, kidney transplant recipients, especially younger ones, should be closely followed in terms of weight gain after transplant.

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

Background

Renal transplantation is the definitive treatment for patients with end-stage renal disease (ESRD). It is associated with better quality of life and patient survival. Nevertheless, these benefits come with rising concerns about weight gain and metabolic abnormalities, which adversely impact transplant outcomes.

Objective

The objective of this study is to estimate the incidence of weight gain in the first year post-renal transplant in addition to the assessment of potential risk factors and the resulting outcome of the graft.

Methods

We conducted a single-center retrospective cohort study of all 295 patients who underwent kidney transplantation at King Abdulaziz Medical City (KAMC) between January 2016 and December 2019. Clinical and laboratory variables were collected from electronic records. Continuous variables were reported as mean ± standard deviation. Comparison between groups was assessed by unpaired t-test or Mann-Whitney U test while follow-up data were compared using paired t-test and repeated measures ANOVA. Association between the potential risk factors and the weight gain was assessed by means of binary logistic regression analysis.

Results

Significant weight gain was observed in 161 (54.6%) patients. Females were 119 (40.30%) of the cohort. The mean age was 45.3±15.1 years. The prevalence of diabetes was 234 (79.6%), while hypertensives constituted 77 (26.3%). The comparison between patients who gained weight significantly and patients with stable weight showed a numerical higher prevalence of female gender in patients who had more weight gain (44.1% vs. 35.8%), higher diabetes, higher rate of a living donor, and statistically significant lower dialysis duration before transplant. Other clinical and laboratory variables were comparable between the two groups.

Conclusion

Our study showed a high incidence of clinically significant weight gain among patients post-renal transplantation. Patients with lower dialysis duration, a living kidney donor and those who are obese at baseline were at higher risk of gaining weight. Patients who underwent kidney transplantation should be monitored closely for weight gain and further studies are needed to determine the risk factors and appropriate interventions.

Comprehensive lifestyle modification as complementary therapy to prevent and manage post-transplant diabetes mellitus*

Post-transplant diabetes mellitus (PTDM) is one from the most common metabolic complications after kidney transplantation. PTDM develops in the early period after transplantation. The risk factors of PTDM are carbohydrate imbalances occurring in the patient prior to transplantation, surgery and the inclusion of immunosuppressive treatment. Kidney transplant patients tend to gain weight, which is associated with an increased risk of post-transplant diabetes, cardiovascular diseases and abnormal transplanted kidney function. Patients after kidney transplantation should be advised to adopt a lifestyle based on a proper diet, exercise, weight control and smoking cessation. The strategy to reduce the risk factors for PTDM development should start before transplantation and continue after kidney transplantation. A targeted, non-pharmacological approach to patients already during the dialysis period may have a significant impact on reducing post-transplantation diabetes. Lifestyle interventions can effectively reduce the risk of development and inhibit the progression of post-transplantation diabetes. The article describes elements of comprehensive non-pharmacological management based on available knowledge of rehabilitation, dietetics and psychology.

Risk factors associated with weight gain after kidney transplantation: A cohort study

BACKGROUND

Renal transplantation is the best modality of renal replacement therapy for patients with end-stage renal disease. However, it is associated with weight gain and metabolic abnormalities, which adversely impact transplant outcomes.

OBJECTIVE

The objective of this study was to identify the risk factors of one-year weight gain after renal transplantation.

METHODS

A retrospective cohort study was conducted with 374 patients that underwent kidney transplantation between January 2006 and July 2013. Clinical and laboratory variables were collected from electronic records, and the outcome of interest was weight gain during the first year after renal transplantation. The data were reported as mean ± standard deviation, median (interquartile range) or number of subjects (%). The association between variables were assessed via chi-square test and ANOVA. For analysis of risk factors related to the outcomes of interest, multivariable logistic regression models were used.

RESULTS

There were 181 (48.4%) female patients, 334 (89.3%) with white ethnicity and the mean age was 44.4 ± 12.8 years. The mean BMI pre-transplant was 24.7 ± 4.1 kg/m2, and 35 (9.9%) patients were classified as obese; 119 (33.6%) as overweight; 187 (52.8%) as normal weight; and 13 (3.7%) as malnourished. After one year of follow-up, the mean BMI was 26.2 ± 5.0 kg/m2, and 61 (17.3%) patients were classified as obese; 133 (37.8%) as overweight; 148 (42.0%) as normal weight; and 10 (2.8%) as malnourished. Weight gain was observed in 72.7% patients, and the average increase was 7.12 ± 5.9 kg. The female gender, lower pre-transplant body weight, lower number of hospitalizations, and a kidney received from a living donor were associated with weight gain by more than 5% in the first year post-transplant.

CONCLUSION

Female gender and lower pre-transplant body weight were independently associated with weight gain by more than 5% in the first year after kidney transplantation; lower rates of hospitalization and donation from living donors were also risk factors for this outcome.

Modifiable Variables Are Major Risk Factors for Posttransplant Diabetes Mellitus in a Time-Dependent Manner in Kidney Transplant: An Observational Cohort Study

Modifiable and nonmodifiable risk factors for developing posttransplant diabetes mellitus (PTDM) have already been established in kidney transplant setting and impact adversely both patient and allograft survival. We analysed 450 recipients of living and deceased donor kidney transplants using current immunosuppressive regimen in the modern era and verified PTDM prevalence and risk factors over three-year posttransplant. Tacrolimus (85%), prednisone (100%), and mycophenolate (53%) were the main immunosuppressive regimen. Sixty-one recipients (13.5%) developed PTDM and remained in this condition throughout the study, whereas 74 (16.5%) recipients developed altered fasting glucose over time. Univariate analyses demonstrated that recipient age (46.2 ± 1.3vs. 40.7 ± 0.6 years old, OR 1.04; P = 0.001) and pretransplant hyperglycaemia and BMI ≥ 25 kg/m2 (32.8% vs. 21.6%, OR 0.54; P = 0.032 and 57.4% vs. 27.7%, OR 3.5; P < 0.0001, respectively) were the pretransplant variables associated with PTDM. Posttransplant transient hyperglycaemia (86.8%. 18.5%, OR 0.03; P = 0.0001), acute rejection (P = 0.021), calcium channel blockers (P = 0.014), TG/HDL (triglyceride/high-density lipoprotein cholesterol) ratio ≥ 3.5 at 1 year (P = 0.01) and at 3 years (P = 0.0001), and tacrolimus trough levels at months 1, 3, and 6 were equally predictors of PTDM. In multivariate analyses, pretransplant hyperglycaemia (P = 0.035), pretransplant BMI ≥ 25 kg/m2 (P = 0.0001), posttransplant transient hyperglycaemia (P = 0.0001), and TG/HDL ratio ≥ 3.5 at 3-year posttransplant (P = 0.003) were associated with PTDM diagnosis and maintenance over time. Early identification of risk factors associated with increased insulin resistance and decreased insulin secretion, such as pretransplant hyperglycaemia and overweight, posttransplant transient hyperglycaemia, tacrolimus trough levels, and TG/HDL ratio may be useful for risk stratification of patients to determine appropriate strategies to reduce PTDM.