Poster Presentation Australian & New Zealand Obesity Society 2014 Annual Scientific Meeting

Challenges in weight management post renal transplant in paediatrics (#208)

Kate S Holland 1 , Kathryn A Marks 1 , Stephen I Alexander 1 , Shirley M Alexander 1
  1. The Children's Hospital, Westmead, Westmead

Introduction: Excessive weight gain after renal transplantation (RTx) is a known complication in paediatric patients, with the main increases occurring three to six months post transplantation. Obesity is independently associated with negative patient outcomes.  Cardiovascular disease is a significant cause of death in adulthood in paediatric patients with end stage renal disease (ESRD). To address the growing problem of obesity in this cohort, a nutrition education program was developed.

Aim: To reduce BMI z-score by 0.25 in 6 months in obese paediatric patients post renal transplantation.

Methods: A nutrition education program was developed by two paediatric dietitians with expertise in weight management and renal nutrition. The program was delivered over six months between June and November 2012 at a tertiary paediatric hospital in NSW, The Children’s Hospital at Westmead (CHW). The sessions were run during existing clinic time to minimise patient burden. Twelve paediatric patients (aged 9.58±4.12 years) were included. Primary outcome was reduction in BMI z-scores. Secondary outcome included improvements in food knowledge.

Results: Mean attendance rate was 1.83±1.59 out of six sessions. Mean BMI z-scores increased from time of RTx (-0.15±1.13), to onset of the program (0.96±1.46), to completion of the program (0.99±1.29). Attendance at group sessions did not influence BMI z-scores. A positive correlation was seen between steroid dose and increase in BMI z-score (r=0.580, p <0.05). Knowledge increased after attending the sessions, as indicated by improvement in pre and post nutrition questionnaires.

Conclusion: This cohort requires a revised strategy to engage them.  Improved nutrition knowledge did not translate into behavioural change measurable by BMI z-score. Future directions for successful weight management in this patient population may require utilisation of joint expertise from the obesity and renal medical teams prior to RTx.