Metabolic syndrome and cardiovascular outcomes in pediatric kidney transplant recipients: A cross-sectional observational study
Anshuman Saha1, Bhavik Champaneri2, Vaidehi Patel3, Harda Shah4, Shahenaz Kapadia1, Kinnari Vala1, Disha Bhatt1, Himanshu Patel5, Manisha Modi6, Pranjal Modi7.
1Pediatric Nephrology, Institute of Kidney Diseases and Research Centre, Ahmedabad, India; 2Pediatric Cardiology, U N Mehta Institute of Cardiology and Research Centre, Ahmedabad, India; 3Radiology, Institute of Kidney Diseases and Research Centre, Ahmedabad, India; 4Physiotherapy, Institute of Kidney Diseases and Research Centre, Ahmedabad, India; 5Nephrology, Institute of Kidney Diseases and Research Centre, Ahmedabad, India; 6Anaesthesia, Institute of Kidney Diseases and Research Centre, Ahmedabad, India; 7Urology, Institute of Kidney Diseases and Research Centre, Ahmedabad, India
Background: The study aimed to determine the prevalence of obesity and metabolic syndrome (MS) and analyze the cardiovascular outcomes in pediatric kidney transplant recipients from a single centre in India.
Methods: Determinants of obesity and MS like weight, height, Body mass index (BMI), blood pressure, fasting blood sugar, triglyceride and high-density lipoprotein (HDL) were collected for children with at least 1 year follow-up post-transplant. Cardiovascular outcomes were hypertension, left ventricular hypertrophy (LVH) and Carotid intima medial thickness (cIMT). LVH was defined by left ventricular mass index ≥51 kg/ht2.7. Diagnosis of obesity and MS were done by applying recommendations from the Pediatric Renal Nutrition Taskforce. Cardiovascular and graft outcomes were compared between the MS and non-MS groups.
Results: The cohort's median age (32 recipients, 71% male) was 14 years (IQR 12,15). At median 21.5 months (IQR 17,37.5) after the first kidney transplantation, 9 out of 32 (28.1%) had MS. Seven were overweight, and 2 were obese (median BMI-height age z score 1.4). Two overweight children did not have MS. Sixteen (50%) had hypertriglyceridemia, 6 (18.7%) had fasting hyperglycemia, and 10 (31%) had low HDL. Eighteen (56%) had hypertension. Seven (77.8%) in the MS group, compared to 11 (47.8%) in the non-MS (p=0.68) were hypertensive. Sixteen (50%) had LVH. Six (66.6%) in MS compared to 10 (43.5%) in non-MS (p=0.26) had LVH. All the recipients, irrespective of MS, had cIMT>95th centile. The mean eGFR in ml/min/1.73m2 was lower in MS (81.26) vs non-MS (76.1) (p=0.67).
Conclusion: 28.1% had metabolic syndrome. A high proportion had dyslipidemia. Hypertension and LVH were more common in the MS group than in the non-MS group, but this difference was not statistically significant. Graft function was similar in both groups.
[1] Metabolic Syndrome
[2] Left ventricular hypertrophy
[3] Hypertension
[4] Kidney transplantation
[5] Children