Obesity in the end stage kidney disease population

1. Obesity in the end stage kidney disease population Dr Maleeka Ladhani PhD Candidate, Sydney School of Public Health Prof Jonathan Craig, A/P Germaine Wong

2. Framework • 1) Prevalence of obesity in the incident and prevalent ESKD population • 2) Access to transplantationfor those with obesity

3. Prevalence of obesity in ESKD

4. 27% 19% Australian Institute of Health and Welfare 2015. Cardiovascular disease, diabetes and chronic kidney disease— Australian facts: Risk factors. Cardiovascular, diabetes and chronic kidney disease series no. 4. Cat. no. CDK 4. Canberra: AIHW.

5. Aims • To describe the trends of obesity in the incident and prevalent Australian and New Zealand ESKD population, over time • Specifically stratifying by: • country • sex • age • diabetes status • modality of renal replacement

6. Methods • All adult Australian and New Zealand patients • 1995 – 2014 • 49,884 patients (8,745 NZ - 32% Maori) • 286,500 observations over the whole period • BMI categorised according to WHO definition

7. Obesity in incident RRT patients ieBMI at RRT initiation for all adult patients

8. Australia and New Zealand

9. Sex differences - Australia

10. Sex differences – New Zealand

11. AgeAust

12. AgeNZ

13. Diabetes -Australia

14. Diabetes – New Zealand

15. Modality – Australia

16. Modality – New Zealand

17. Obesity in prevalent patients ie all patients on RRT each year

18. Australia and New Zealand

19. Modality – Australia

20. Modality – New Zealand

21. Access to transplantation

22. BMI association with all-cause mortality Ladhani et al, NDT 2016

23. BMI association with all-cause mortality Ladhani et al, NDT 2016

24. Chang et al Transplantation 2007

25. Chang et al Transplantation 2007

26. Aims • To examine access to transplantation for people with obesity in 3 ways • 1) Pre-emptive transplantation • 2) Time to first transplant • 3) Placement on the waiting list

27. Methods • 1) Pre-emptive transplantation • Descriptive data limited to 2014 • 2) Time to first transplant • Kaplan Meier curve restricted to incident patients • <70 years, 1995-2014 • 3) Placement on the waiting list • Logistic regression limited to 2014 and patients <70 years with outcome of listed or not listed • Adjusted for relevant confounders +/- centre effect

28. Pre-emptive transplantation

29. Time to transplantation

30. Baseline stats

31. Baseline stats

33. Centre effect modeled as a random intercept

34. Conclusions • Obesity is increasingly common in the ESKD population • Despite evidence that long term patient and graft outcomes are not affected by obesity, people with obesity are: • less likely to start RRT with a transplant • less likely to receive a transplant over time • less likely to be on the waiting list for a transplant– despite adjusting for confounders

35. Implications • There appears to be a discrepancy in access to transplantation for people with obesity that is not supported by long term outcome studies • This needs to be looked at further • Thank you to all ANZDATA contributors