Pre-kidney transplant unintentional weight loss leads to worse post-kidney transplant outcomes

Meera N Harhay; Xiaomeng Chen; Nadia M Chu; Silas P Norman; Dorry L Segev; Mara McAdams-DeMarco

doi:10.1093/ndt/gfab164

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Pre-kidney transplant unintentional weight loss leads to worse post-kidney transplant outcomes

Journal article

Open access

Peer reviewed

Pre-kidney transplant unintentional weight loss leads to worse post-kidney transplant outcomes

Meera N Harhay, Xiaomeng Chen, Nadia M Chu, Silas P Norman, Dorry L Segev and Mara McAdams-DeMarco

Nephrology, dialysis, transplantation, v 36(10), pp 1927-1936

27 Sep 2021

DOI: https://doi.org/10.1093/ndt/gfab164

PMID: 33895851

Featured in Collection : UN Sustainable Development Goals @ Drexel

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Abstract

Female

Graft Survival

Humans

Kidney Transplantation - adverse effects

Middle Aged

Prospective Studies

Risk Factors

Transplant Recipients

Weight Loss

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. 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%)]. 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/m2/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. This study suggests that unintentional, but not intentional, pre-KT weight loss is an independent risk factor for adverse post-KT outcomes.

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Details

Title: Pre-kidney transplant unintentional weight loss leads to worse post-kidney transplant outcomes
Creators: Meera N Harhay - Drexel University
Xiaomeng Chen - Johns Hopkins University
Nadia M Chu - Johns Hopkins University
Silas P Norman - University of Michigan
Dorry L Segev - Johns Hopkins University
Mara McAdams-DeMarco - Johns Hopkins University
Publication Details: Nephrology, dialysis, transplantation, v 36(10), pp 1927-1936
Publisher: Oxford University Press
Grant note: R01 AG055781 / NIA NIH HHS K01 AG064040 / NIA NIH HHS K23 DK105207 / NIDDK NIH HHS R01 DK124388 / NIDDK NIH HHS K24 AI144954 / NIAID NIH HHS
Resource Type: Journal article
Language: English
Academic Unit: College of Medicine
Web of Science ID: WOS:000704005900021
Scopus ID: 2-s2.0-85117371026
Other Identifier: 991019335226604721