Kidney Week

Abstract: SA-PO0499

An Integrated Nephrology-Obesity Medicine Clinic to Improve Weight Management Access for Kidney Transplant Candidates

Session Information

• CKM: Clinical - Screening, Population Management, Care Disparities, and Patient-Centered Outcomes
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Cardiovascular-Kidney-Metabolic Health

• 602 Cardiovascular-Kidney-Metabolic Health: Clinical

Authors

• Lavenburg, Linda-Marie Ustaris, University of Pittsburgh, Pittsburgh, Pennsylvania, United States

Linda-Marie Ustaris Lavenburg, DO, MS

• Sierra Mendoza, Mariela M., UPMC, Pittsburgh, Pennsylvania, United States

Mariela M. Sierra Mendoza, MD

• Morford, Harry, UPMC, Pittsburgh, Pennsylvania, United States

Harry Morford

• Stark, Susan A., UPMC, Pittsburgh, Pennsylvania, United States

Susan A. Stark, MS, RD

• Puttarajappa, Chethan M., University of Pittsburgh, Pittsburgh, Pennsylvania, United States

Chethan M. Puttarajappa, MD, MS

Background

Obesity is a major barrier to kidney transplantation (KT), particularly for people with body mass index (BMI) ≥40kg/m². At the University of Pittsburgh Medical Center (UPMC), prior evaluation identified system-related barriers contributing to low engagement with weight management (WM) among KT candidates ineligible for transplantation due to obesity. Although 59 patients were offered a WM referral, only 9 of 30 who accepted referral established care between 2022-2024. We aimed to improve the WM referral workflow and identify reasons for referral decline.

Methods

As part of a UPMC-approved quality improvement initiative launched in February 2025, we redesigned the KT-to-WM referral workflow and established an integrated Nephrology–Weight Management (NephWM) clinic led by a dual board-certified nephrologist and obesity medicine physician. KT candidates with BMI≥40kg/m² were offered referral to the NephWM clinic. When referrals were accepted, the KT team notified the NephWM clinic through the electronic record, and clinic staff contacted patients to schedule appointments. The primary outcome was completion of the initial appointment with the NephWM clinic. Process measures included referral acceptance, decline, scheduling outcomes, and reasons for referral decline. Descriptive statistics summarized outcomes and process measures.

Results

Between 2/1/2025–2/28/2026, 82 patients undergoing KT evaluation but ineligible due to BMI≥40kg/m² were offered referral to the NephWM clinic. Participants were 42.7% male, 70.7% White, 28.0% Black, 67.9% dialysis dependent, and 65.8% had diabetes. Among those offered referral, 57 (69.5%) accepted, 19 (23.2%) declined, and 6 (7.3%) could not be contacted. Reasons for referral decline included travel difficulty, lack of interest, or time commitment. Of the 57 individuals who accepted referral, 24 (42.1%) completed an initial appointment, 15 (26.3%) scheduled a future appointment, 3 (5.3%) died, and 15 (26.3%) canceled, no-showed, or still needed scheduling.

Conclusion

A proactive collaborative care model with integrated WM streamlined access to obesity treatment for KT candidates with severe obesity. This may represent a scalable strategy to address system- and patient-level barriers to care and improve access to obesity treatment among KT candidates. Ongoing evaluation will assess effects on KT waitlisting and transplantation outcomes.

Acknowledgment

Artificial intelligence (ChatGPT, OpenAI) was used to improve sentence structure, clarity, conciseness, and overall readability of the abstract. AI-generated suggestions were reviewed, edited, and approved by the authors, who take full responsibility for the final content of the manuscript.