Pediatric kidney transplant and cardiometabolic risk: a cohort study

Mosca, Sara; Gregório, Bárbara; Costa, Teresa; Correia-Costa, Liane; Mota, Conceição

doi:10.1590/2175-8239-JBN-2021-0202

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Brazilian Journal of Nephrology

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Original Articles • Braz. J. Nephrol. 44 (4) • Oct-Dec 2022 • https://doi.org/10.1590/2175-8239-JBN-2021-0202 copy

Pediatric kidney transplant and cardiometabolic risk: a cohort study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction:

Patients with chronic kidney disease (CKD) are known to have increased cardiovascular risk but there are few data on the risk of pediatric kidney transplant recipients. We aimed to assess the impact of pre- and post-transplant overweight on allograft function and to characterize the evolution of several cardiovascular risk variables over time and their impact.

Methods:

A retrospective analysis of the records of 23 children/adolescents followed at a tertiary center after kidney transplant was conducted. Data on anthropometry and cardiometabolic variables were analyzed before transplant, six and 12 months after the transplant, and at the last follow-up visit. The impact of the variables on allograft function (glomerular filtration rate (GFR)) was estimated by creatinine-based revised Schwartz formula (Cr-eGFR) and was evaluated using nonparametric tests. Results: The 23 patients included in the study had a median age of 6.3 (4.4-10.1) years. Both systolic and diastolic BP z-score values significantly decreased between BMI groups [1.2 (-0.2 - 2.3) vs. 0.3 (-0.4 - 0.6), p=0.027 and 0.8 (-0.4 - 1.3) vs. 0.1 (-0.6 - 0.7), p=0.028, pre-transplant and at the final evaluation, respectively]. During follow-up, GFR values decreased (Cr-GFR: 68.9 (57.7-76.8) vs. 58.6 (48.9-72.9), p=0.033 at 6-months and at the end, respectively). Significant negative correlations between triglycerides and cystatin C-based eGFR (ρ=-0.47, p=0.028) and Cr-Cys-eGFR (ρ=-0.45, p=0.043) at the end of the study were found.

Conclusion:

Our study showed a high number of overweight children undergoing kidney transplant. A negative correlation between triglycerides and GFR was found, which highlights the importance of managing nutritional status and regular blood lipids evaluation after kidney transplant.

Keywords:
Allograft; Cardiometabolic Risk Factors; Dyslipidemias; Renal Insufficiency; Pediatric Obesity; Kidney Transplantation

	All n=23	Non-overweight^* * BMI z-score classes were defined according to the World Health Organization criteria; the overweight group includes overweight and obese patients20 n=15	Overweight^* * BMI z-score classes were defined according to the World Health Organization criteria; the overweight group includes overweight and obese patients20 n=8	p
Male sex	17 (73.9%)	10 (66.7%)	7 (87.5%)	0.369
Age at transplantation (years)	6.3 (4.4-10.1)	7.8 (4.4-10.1)	6.1 (3.2-11.8)	0.846
Primary kidney disease				0.311
Non- CAKUT	9 (39.1%)	7 (46.7%)	2 (25.0%)
CAKUT	14 (59.9%)	9 (53.3%)	6 (75.0%)
Neurogenic bladder	2 (8.7%)	1 (6.7%)	1 (6.7%)	0.636
Pre-transplant modality				0.453
Preemptive	1 (4.5%)	1 (6.7%)	-
Hemodialysis	3 (13.6%)	1 (6.7%)	2 (25%)
Peritoneal dialysis	13 (59.1%)	10 (66.7%)	3 (37.5%)
Hemodialysis / Peritoneal dialysis	6 (27.2%)	3 (20.0%)	3 (37.5%)
Dialysis duration (months)	19.0 (7.0-51.0)	14.0 (5.8-51.2)	19.0 (10.5-51.0)	0.578
Deceased donor	19 (82.6%)	13 (86.7%)	6 (75.0%)	0.589
Follow-up after transplant (years)	7.4 (3.4-9.5)	8.2 (7.4-10-9)	3.2 (2.7-4.3)	<0.001
Anthropometric data^ Anthropometric and blood pressure data collected at the last appointment before kidney transplant.
Weight (kg)	19.0 (14.4-27.0)	19.0 (14.4 - 26.4)	18.9 (13.9-37.4)	0.699
Height (cm)	108.0 (97.5 - 126.5)	117.0 (102.0 - 127.5)	103.5 (85.0 - 123.8)	0.258
BMI (kg/m2)	16.9 (15.6 - 19.6)	15.8 (15.0 - 16.9)	21.2 (17.8 - 23.2)	<0.001
z-score	0.4 (-0.3 - 1.3)	0.01 (-0.9 - 0.4)	1.4 (1.2 - 2.4)	<0.001
Office blood pressure data^ Anthropometric and blood pressure data collected at the last appointment before kidney transplant.
SBP (mmHg)	105.0 (94.0 - 124.0)	105.0 (94.0 - 120.0)	110.5 (89.0 - 128.5)	0.698
z-score	1.2 (-0.2 - 2.3)	1.2 (-0.2 - 1.99)	1.4 (-0.2 - 2.3)	0.673
DBP (mmHg)	61.0 (51.0 - 74.0)	60.0 (52.0 - 77.0)	61.0 (41.8 - 69.8)	0.301
z-score	0.8 (-0.4 - 1.3)	1.1 (-0.3 - 1.8)	0.1 (-0.9 - 1.0)	0.114
High BP^ Anthropometric and blood pressure data collected at the last appointment before kidney transplant. ^* * BMI z-score classes were defined according to the World Health Organization criteria; the overweight group includes overweight and obese patients20	9 (39.1%)	6 (40.0%)	3 (37.5%)	0.673

	Pre-Tx (n=23)	6 Months (n=23)	12 Months (n=23)	End of Study (n=23)	ΔPre-Tx-End of study	Δ6M- End of study
BMI (kg/m2)	16.9 (15.6 - 19.6)	18.0 (15.5-20.9)	16.6 (15.5-20.9)	20.6 (18.0-24.4)	0.004	0.003
z-score	0.4 (-0.3 - 1.3)	0.8 (-0.1-1.6)	0.5 (-0.5 - 1.6)	0.3 (-0.8-1.3)	0.651	0.040
Overweight^* * BMI z-score classes were defined according to the World Health Organization criteria; the overweight group includes overweight and obese patients20	8 (34.8%)	12 (52.2%)	11 (47.8%)	10 (43.5%)	0.179	0.019
SBP (mmHg)	105.0 (94.0 - 124.0)	102 (88-111)	103 (99-110)	110 (103-121)	0.404	0.001
z-score	1.2 (-0.2 - 2.3)	0.5 (-0.8 - 0.9)	0.4 (-0.2 - 1.04)	0.3 (-0.4 - 0.6)	0.027	0.765
DBP (mmHg)	61.0 (51.0 - 74.0)	57 (53-66)	62 (57-66)	63 (56-69)	0.578	0.020
z-score	0.8 (-0.4 - 1.3)	0.4 (-0.7 - 0.7)	0.4 (-0.4 - 0.6)	0.1 (-0.6-0.7)	0.028	0.627
High BP^ High blood pressure includes patients with elevated BP and with hypertension (stage 1 and stage 2), according to the 2017 American Academy of Pediatrics guidelines21 BMI: body mass index; BP: blood pressure; DBP: diastolic blood pressure; HDL: high density lipoprotein; HOMA-IR: homeostasis model assessment of insulin resistance; LDL: low density lipoprotein; NA: not available; Pre-Tx: pre-transplant; SBP: systolic blood pressure.	9 (39.1%)	3 (13.0%)	5 (21.7%)	3 (13.0%)	0.075	0.263
Total cholesterol (mg/dL)	NA	163.0 (139.8-187.5)	146.0 (128.0-169.0)	149.0 (136.0-170.0)	-	0.008
LDL cholesterol (mg/dL)	NA	91.0 (71.5-122)	83.5 (68.2-104.5)	83.0 (71.0-109.0)	-	0.705
HDL cholesterol (mg/dL)	NA	52.0 (37.8-62.5)	44.5 (36.4-53.8)	49.0 (38.0-57.0)	-	0.112
Triglycerides (mg/dL)	NA	111.0 (77.3-139.5)	100.5 (88.0-127.5)	86.0 (72.0-125.0)	-	0.035
Glucose (mg/dL)	NA	80.0 (75.5-85.5)	81.0 (70.2-87.8)	83.0 (76.0-87.0)	-	0.206
Insulin (µIU/mL)	NA	NA	NA	9.8 (6.2-14.3)	-	-
HOMA-IR	NA	NA	NA	1.9 (1.3-3.0)	-	-

	6 Months (n=23)	12 Months (n=23)	End of Study (n=23)	Δ6M-End of study
Creatinine (mg/dL)	0.7 (0.6-0.9)	0.7 (0.5-0.9)	1.1 (0.9-1.3)	<0.001
Urea (mg/dL)	50.0 (40.3-67.5)	46.0 (35.2-65.5)	63.5 (42.8-79)	0.060
Cystatin (mg/L)	1.2 (1.1-1.5)	1.4 (1.1-1.8)	1.5 (1.3-1.9)	0.136
Cr-eGFR (mL/min/1.73m2)^* * Cr-eGFR: creatinine-based estimated glomerular filtration rate (Schwartz formula)23	68.9 (57.7-76.8)	71.3 (57.6-86.0)	58.6 (48.9-72.9)	0.033
Cys-eGFR(mL/min/1.73m2)^ Cys-GFR: cystatin C-based estimated glomerular filtration rate (Filler formula)23	73.6 (60.5-77.9)	62.6 (47.0-81.3)	58.3 (45.3-70.6)	0.071
Cr-Cys-eGFR (mL/min/1.73m2)^ Cys-GFR: cystatin C-based estimated glomerular filtration rate (Filler formula)23 ^* * Cr-eGFR: creatinine-based estimated glomerular filtration rate (Schwartz formula)23	66.1 (57.1-71.9)	55.8 (48.8-77.7)	47.6 (42.8-64.3)	0.015

	Cr-eGFR (n=23)	Cys-eGFR (n=23)	Cr-Cys-eGFR (n=23)
BMI (kg/m2)
6-Months	0.37	0.27	0.27
12-Months	0.23	0.18	0.12
End of study	0.02	-0.02	0.02
BMI z-score
6-Months	0.31	0.07	0.12
12-Months	0.19,	0.11	0.06
End of study	0.07	-0.02	0.01
SBP (mmHg)
6-months	0.43	0.42^* * p value <0.05	0.37
12-months	0.46^* * p value <0.05	0.43	0.39
End of study	0.16	0.39	0.30
DBP (mmHg)
6-months	0.34	0.42	0.32
12-months	0.15	0.07	0.14
End of study	-0.07	0.21	0.16
Total cholesterol (mg/dL)
6-months	0.01	-0.31	-0.15
12-months	-0.24	-0.17	-0.27
End of study	-0.04	-0.18	-0.10
LDL cholesterol (mg/dL)
6-months	0.07	-0.08	0.001
12-months	-0.28	-0.16	-0.28
End of study	-0.19	- 0.19	-0.18
HDL cholesterol (mg/dL)
6-months	0.06	-0.18	-0.16
12-months	0.10	-0.01	0.02
End of study	0.26	0.23	0.31
Triglycerides (mg/dL)
6-months	-0.12	0.19	0.34
12-months	- 0.20	- 0.12	-0.11
End of study	- 0.34	- 0.47^* * p value <0.05	-0.45^* * p value <0.05
Glucose (mg/dL)
6-months	-0.28	-0.23	-0.23
12-months	-0.23	-0.33	-0.33
End of study	0.09	0.06	0.02
Insulin (µIU/mL)
6-months	NA	NA	NA
12-months	NA	NA	NA
End of study	0.01	-0.15	-0.05
HOMA-IR
6-months	NA	NA	NA
12-months	NA	NA	NA
End of study	-0.02	-0.17	-0.06

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[1] Correspondence to: Sara Mosca. E-mail: sara.mosca.silva@gmail.com