Kidney Week

Abstract: SA-PO948

Barriers to Obesity Management in Kidney Transplant Candidates

Session Information

• Transplantation: Clinical - 3
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2102 Transplantation: Clinical

Authors

• Lavenburg, Linda-Marie Ustaris, University of Pittsburgh, Pittsburgh, Pennsylvania, United States

Linda-Marie Ustaris Lavenburg, DO, MS

• Morford, Harry, UPMC, Pittsburgh, Pennsylvania, United States

Harry Morford

• Kamat, Sanjana Sunil, Conemaugh Memorial Medical Center, Johnstown, Pennsylvania, United States

Sanjana Sunil Kamat, MD

• Molinari, Michele, UPMC, Pittsburgh, Pennsylvania, United States

Michele Molinari, MD, MSc

• Stark, Susan A., UPMC, Pittsburgh, Pennsylvania, United States

Susan A. Stark, MS, RD

• Puttarajappa, Chethan M., University of Pittsburgh, Pittsburgh, Pennsylvania, United States

Chethan M. Puttarajappa, MD, MS

Background

Obesity poses significant barriers to kidney transplantation (KT). Transplant waitlisting is 30-70% lower for candidates with body mass index (BMI; kg/m²) ≥ 40 compared to BMI ≥18.5 to <25. Although no consensus exists, KT centers often require candidates to have a BMI <35-40 prior to KT. KT candidates are often referred to weight loss programs (WLPs) (e.g., dietitian support, medical weight management, or bariatric surgery) but patients' acceptance for WLP referral and their subsequent follow through are unknown.

Methods

Through a quality improvement project, patients with BMI>43 referred for KT evaluation at our center were offered referral to WLP. A proportion of patients accepting referral and those eventually contacting WLP were evaluated. Differences in patient characteristics among those that accepted vs declined referral and among those that contacted vs did not contact a WLP were evaluated using descriptive statistics and multivariable logistic regression.

Results

Cohort had 59 patients with a median age of 57 years (IQR 49-65), 49% were male, 44% were Black or other race and 56% White, 79% were on dialysis, and 53% were from high social distress areas (area deprivation index ≥80). Of 59 patients, 30 patients (50.8%) accepted referral to a WLP but only 9 contacted WLP. Patients accepting referral had a higher median (IQR) BMI [47 (45-50) vs 45 (41-46); p=0.002] and resided closer to the KT center [20 (3-41) vs 48 (17-67) miles; p=0.010]. In multivariable models, referral acceptance decreased 2% with each mile away from KT center (OR 0.98; 95%CI: 0.96-1.00) and increased by 22% (OR 1.22, 95%CI: 1.03-1.45) with every 1 unit increase in BMI. Among patients accepting referral, every 1 year increase in age reduced odds of contacting WLP by 17% (OR 0.83, 95%CI: 0.74-0.96).

Conclusion

A large share of KT candidates with obesity do not establish care with WLPs. Increasing age and distance to KT center were major barriers. Efforts aimed at obesity management in KT should consider these barriers. WLPs integrated within KT programs may overcome barriers to establishing care with WLPs. Future steps in this study will compare weight trajectories, transplant waitlisting and receipt of a kidney transplant between patients who accepted vs declined WLP referrals.

Funding

• NIDDK Support