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Published on: April 12, 2021
Obesogenic Medication Use in End-Stage Kidney Disease and Association With Transplant Listing
Babak J Orandi1,2, Yiting Li1, Timur Seckin1
1Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA.
Objectives:
Obesogenic medications are a putative contributor to the obesity epidemic. While 20% of adults take ≥1 obesogenic medication, the proportion in the end-stage kidney disease (ESKD) population-a group enriched for cardiometabolic complications-is unknown. Obesogenic medications may contribute to obesity and hamper weight loss efforts to achieve transplant listing.
Methods:
Using 2017-2020 USRDS and Medicare claims, patients were identified as taking obesogenic medications if prescribed anticonvulsants, antidepressants, antidiabetics, anti-inflammatories, antipsychotics, and/or antihypertensives known to cause weight gain for ≥30 days in their first hemodialysis year. Ordinal logistic and Cox regression with inverse probability of treatment weighting were used to quantify obesogenic medications' association with body mass index (BMI) and listing, respectively.
Results:
Among 271 401 hemodialysis initiates, 63.5% took ≥1 obesogenic medication. For those in underweight, normal weight, overweight, and class I, II, and III categories, 54.3%, 58.4%, 63.1%, 66.5%, 68.6%, and 68.8% took ≥1, respectively. Number of obesogenic medications was associated with increased BMI; use of one was associated with 13% increased odds of higher BMI (aOR [adjusted odds ratio] 1.14; 95%CI: 1.13-1.16; p < 0.001), use of three was associated with a 55% increase (aOR 1.55; 95%CI: 1.53-1.57; p < 0.001). Any use was associated with 6% lower odds of transplant listing (aHR [adjusted hazard ratio] 0.94; 95%CI: 0.92-0.96; p < 0.001). Within each BMI category, obesogenic medication use was associated with lower listing likelihood.
Conclusions:
Obesogenic medication use is common in ESKD patients-particularly those with obesity-and is associated with lower listing likelihood. Whenever possible, non-obesogenic alternatives should be chosen for ESKD patients attempting weight loss to achieve transplant listing.
Insights
Obesogenic medications are common in end-stage kidney disease (ESKD) patients, particularly those with obesity. Their use is linked to higher BMI and reduced odds of transplant listing, suggesting alternative medications should be considered.
Area of Science:
- Nephrology
- Pharmacology
- Public Health
Background:
- Obesogenic medications contribute to the obesity epidemic in the general adult population.
- The prevalence and impact of these medications in end-stage kidney disease (ESKD) patients are unknown.
- ESKD patients are at higher risk for cardiometabolic complications and may face challenges with weight management for transplant eligibility.
Purpose of the Study:
- To determine the proportion of ESKD patients on hemodialysis taking obesogenic medications.
- To investigate the association between obesogenic medication use and body mass index (BMI).
- To examine the relationship between obesogenic medication use and the likelihood of being listed for kidney transplantation.
Main Methods:
- Utilized USRDS and Medicare claims data from 2017-2020 for hemodialysis patients.
- Identified obesogenic medications (anticonvulsants, antidepressants, antidiabetics, anti-inflammatories, antipsychotics, antihypertensives) prescribed for ≥30 days.
- Employed ordinal logistic and Cox regression with inverse probability of treatment weighting to analyze associations with BMI and transplant listing.
Main Results:
- 63.5% of 271,401 hemodialysis initiates took at least one obesogenic medication, with higher prevalence in individuals with higher BMI.
- Each additional obesogenic medication was associated with increased odds of higher BMI (e.g., three medications increased odds by 55%).
- Any use of obesogenic medications was associated with a 6% lower likelihood of transplant listing, a trend observed across all BMI categories.
Conclusions:
- Obesogenic medication use is highly prevalent in ESKD patients, especially those with obesity.
- These medications are associated with increased BMI and decreased chances of being listed for kidney transplantation.
- Prioritizing non-obesogenic alternatives for ESKD patients aiming for weight loss and transplant listing is recommended.
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