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Kidney Week

Abstract: PO2523

Use of Weight-Altering Diabetes Medications to Address Obesity as a Barrier to Kidney Transplant Evaluation in Patients with Type 2 Diabetes and Stage 4-5 CKD or ESKD

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Chintam, Kiran, Geisinger Health, Danville, Pennsylvania, United States
  • Mohan, Prince, Geisinger Health, Danville, Pennsylvania, United States
  • Green, Jamie Alton, Geisinger Health, Danville, Pennsylvania, United States
  • Chang, Alex R., Geisinger Health, Danville, Pennsylvania, United States
Background

Many patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) are ineligible for kidney transplant due to high body mass index (BMI). Some medication classes are associated with weight loss (glucagon-like peptide-1 receptor agonists [GLP1-RAs]), neutral-weight (dipeptidyl peptidase-4 inhibitors [DPP4i]), or weight gain (sulfonylureas and insulin).

Methods

We examined the relationship between BMI and use of weight-altering diabetes medications in patients with type 2 diabetes mellitus and stage 4-5 CKD or dialysis-dependent ESKD at Geisinger (1/18-3/20). In addition, we examined whether access to kidney transplant evaluation varied by BMI in patients on dialysis.

Results

Out of 4200 patients with T2DM and stage 4-5 CKD or ESKD, 30% had BMI≥35kg/m2 and 15% had BMI≥40 kg/m2. Overall, use of T2DM medications with favorable weight effects was low, similar to use of sulfonylureas (Table). Patients with severe obesity had higher GLP1-RA use (BMI ≥ 35 vs. <35 kg/m2: 11%, 5%), higher insulin use (69%, 53%), and lower DPP4i use (9%, 13%). Similar findings were noted in the subset of patients on dialysis: GLP1-RAs (BMI ≥ 35 vs. <35 kg/m2: 6% vs. 2%), DPP4is (3% vs. 6%), sulfonylureas (5% vs. 8%), insulin (77%, 74%). In unadjusted analyses, transplant clinic attendance was highest in ESKD patients with BMI 30-34.9 kg/m2 (23%), followed by BMI 35-39.9 (17%), BMI 25-29.9 (15%), BMI 18.5-24.9 (13%), BMI ≥40 (7%), and BMI < 18.5 (5%).

Conclusion

The vast majority of patients with T2DM and advanced CKD are taking obesogenic rather than weight loss-promoting diabetes medications. Those with BMI ≥40 kg/m2 were 3.6x less likely to have been evaluated in transplant clinic than those with class I obesity (BMI 30-34.9 kg/m2). Consideration of the differential impact of certain diabetes medication classes on weight may help improve access to kidney transplantation and long-term outcomes.

Funding

  • NIDDK Support