Kidney Week

Abstract: PO1741

Priorities for Person-Centered Obesity Management in ESKD

Session Information

• Health Maintenance, Nutrition, and Metabolism
  November 04, 2021 | Location: On-Demand, Virtual Only
  Abstract Time: 10:00 AM - 12:00 PM

Category: Health Maintenance, Nutrition, and Metabolism

• 1300 Health Maintenance, Nutrition, and Metabolism

Authors

• Harhay, Meera Nair, Drexel University, Philadelphia, Pennsylvania, United States

Meera Nair Harhay, MD, MS, FASN

• Milliron, Brandy-Joe, Drexel University, Philadelphia, Pennsylvania, United States

Brandy-Joe Milliron,

• Sweeting, Jasmine M., Drexel University, Philadelphia, Pennsylvania, United States

Jasmine M. Sweeting,

• Lee, Joanna H., Drexel University, Philadelphia, Pennsylvania, United States

Joanna H. Lee,

• Hingorany, Sneha S., Drexel University, Philadelphia, Pennsylvania, United States

Sneha S. Hingorany,

• Haileselasse, Jennifer Rachael, Drexel University, Philadelphia, Pennsylvania, United States

Jennifer Rachael Haileselasse,

• Gunen, Bengucan, Drexel University, Philadelphia, Pennsylvania, United States

Bengucan Gunen,

• Klassen, Ann Carroll, Drexel University, Philadelphia, Pennsylvania, United States

Ann Carroll Klassen,

Background

Although obesity is a pervasive kidney transplant barrier, little is known about the social, dietary, and process-of-care challenges to addressing obesity among individuals with ESKD.

Methods

Using purposive sampling we recruited adults with ESKD and obesity (N=40) and ESKD health care professionals (HCPs, N=20) in the United States for semi-structured interviews to elicit perspectives about obesity and barriers and strategies for healthy weight loss. Recorded phone interviews lasting 1.5 hours were transcribed verbatim and analyzed using inductive and deductive thematic analysis.

Results

Median patient age was 55 (interquartile range [IQR] 47,63) years, median dialysis exposure was 5 (IQR 3,10) years, 51% were female, 27% were Black, and median BMI was 37.8 (IQR 33.5, 40.8) kg/m². HCPs were renal dietitians, nephrologists, and transplant surgeons. Five themes emerged from patient interviews: 1) obesity-related counseling typically limited to immediate goal (transplant BMI requirements); 2) obesity as a life-long disease or linked to trauma; 3) food choices driven by fatigue and poor sleep quality; 4) existing nutrition programs not transferable to ESKD; 5) absence of culturally-effective nutrition counseling. HCP interviews revealed uncertainty about provider roles and responsibilities for addressing obesity and underscored that poverty and low health literacy are barriers to healthy weight loss.

Conclusion

Obesity-related care for people with ESKD is often limited to addressing BMI limits for transplant. Weight loss interventions for people with ESKD and obesity should be tailored with knowledge of social and financial context and a shift in focus from short-term goals to long-term health.

Geographic distribution of semi-structured interview respondents, including patients with dialysis-dependent kidney disease and obesity, renal dietitians, nephrologists, and transplant surgeons.

Funding

• NIDDK Support