Background: Children with kidney disease have altered body composition and short stature that may not be accurately assessed by standard methods. The measure of obesity that best predicts cardiovascular (CV) risk in pediatric kidney transplant (tx) recipients has not been established.

Objective: A prospective cohort study was conducted to investigate ability of BMI, waist circumference (WC), and waist-to-height ratio (WHr) to identify CV risk in pediatric kidney tx recipients.

Methods: Tx recipients, age 3-20 years, had echo, carotid intima-media thickness (CIMT), BMI, WC, WHr, blood pressure, lipids and leptin measured at 1, 18, and 30 months post-tx. Receiver Operator Characteristic (ROC) analysis was used to compare ability of BMI, WC, and WHr to detect a composite adverse CV outcome. Presence of the composite outcome was defined by ≥3 of the following:1) left ventricular hypertrophy 2) high CIMT 3) impaired myocardial strain 4) dyslipidemia 5) hypertension.

Results: Analysis of 116 visits of 42 children over 1 to 30 months post-tx was conducted. Prevalence of obesity by WHr (43.5%) was higher vs. BMI (24.1%) and WC (12.0%), p<0.03. Children obese by WHr had twice the composite adverse CV outcomes (62.2%) vs. BMI (34.6%) and WC (33.3%) obese. Leptin of obese was greater than lean (Table 1). Sensitivity of WHr-obesity is highest to predict adverse CV outcomes (area under the ROC curve 0.77 vs. 0.47 for BMI and 0.48 for WC, p=0.0006), see Figure.

Conclusions: WHr is more sensitive than BMI or WC to detect adiposity-associated adverse CV outcomes among pediatric kidney tx recipients.

CITATION INFORMATION: Sgambat K., Clauss S., Moudgil A. Comparison of BMI, Waist Circumference and Waist-to-Height Ratio for Identification of Cardiovascular Risk in Pediatric Kidney Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

« Back to 2018 American Transplant Congress