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Effects of obesity and metabolic syndrome on cardiovascular outcomes in pediatric kidney transplant recipients: a longitudinal study

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A Correction to this article was published on 02 March 2018

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Abstract

Background

Obesity and metabolic syndrome (MS) are common after kidney transplantation, but their contribution to adverse cardiovascular (CV) outcomes in children are not well known. A prospective, controlled, longitudinal cohort study was conducted to investigate the effects of obesity and MS on left ventricular hypertrophy (LVH) and myocardial strain in pediatric kidney transplant recipients.

Methods

Transplant recipients (n = 42) had anthropometrics [body mass index (BMI), waist circumference, waist-to-height ratio], biochemical parameters (fasting glucose, lipid panel, HbA1c%), and echocardiogram with speckle tracking analysis for strain measured at 1, 18, and 30 months post-transplant. Additionally, 35 pre-transplant echocardiograms were analyzed retrospectively. Healthy children (n = 24) served as controls.

Results

Waist-to-height ratio detected abdominal obesity in 46% of transplant patients, whereas only 8.1% were identified as obese by waist circumference. Ejection fraction and fractional shortening of the transplant group were normal. Prevalence of LVH was 35.2%, 17.1%, and 35.5% at 1, 18, and 30 months respectively. The longitudinal strain of transplant group was worse than controls at all time points (p < 0.001). Hemodialysis was independently associated with 21% worse longitudinal strain during the pre-transplant period (p = 0.04). After transplantation, obesity, MS, and systolic hypertension predicted increased odds of LVH (p < 0.04). Worse longitudinal strain was independently associated with obesity, MS, hypertension, and the combination of MS with elevated low density lipoprotein (LDL) cholesterol (p < 0.04), whereas higher estimated glomerular filtration rate (eGFR) conferred a protective effect (p < 0.001).

Conclusion

Obesity and MS adversely affect CV outcomes after transplantation. Further studies are needed to investigate speckle tracking echocardiography as a tool for early detection of subclinical myocardial dysfunction in this population.

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Fig. 1: Longitudinal strain of lean and obese transplant recipients vs. controls
Fig. 2: Relationship of metabolic syndrome and LDL cholesterol with longitudinal strain

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Change history

  • 02 March 2018

    As originally published, this article contained errors owing to oversights in typesetting. The article has now been amended accordingly.

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Authors and Affiliations

  1. Department of Nephrology, Children’s National Health System, Washington, DC, USA

    Kristen Sgambat & Asha Moudgil

  2. Department of Cardiology, Children’s National Health System, Washington, DC, USA

    Sarah Clauss & Margaret Lasota

  3. Department of Nutrition, University of Maryland, College Park, MD, USA

    K. Y. Lei & Shaik O. Rahaman

  4. Department of Animal and Avian Sciences, University of Maryland, College Park, MD, USA

    Jiuzhou Song

Authors
  1. Kristen Sgambat
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  2. Sarah Clauss
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  3. K. Y. Lei
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  4. Jiuzhou Song
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  5. Shaik O. Rahaman
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  6. Margaret Lasota
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  7. Asha Moudgil
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Corresponding author

Correspondence to Kristen Sgambat.

Ethics declarations

Approval was obtained from the Institutional Review Board (IRB) at Children’s National. Informed consent was obtained from all participants and the study was performed in accordance with the Declaration of Helsinki.

Conflicts of interest

The authors declare that they have no conflicts of interest.

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This article has been revised to correct errors made in typesetting.

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Sgambat, K., Clauss, S., Lei, K.Y. et al. Effects of obesity and metabolic syndrome on cardiovascular outcomes in pediatric kidney transplant recipients: a longitudinal study. Pediatr Nephrol 33, 1419–1428 (2018). https://doi.org/10.1007/s00467-017-3860-8

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  • DOI: https://doi.org/10.1007/s00467-017-3860-8

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