Department of Surgery, New York University Grossman School of Medicine, New York, New York, USA.
Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA.
Clin Transplant. 2024 Aug;38(8):e15414. doi: 10.1111/ctr.15414.
Obesogenic medications are a putative contributor to the obesity epidemic. While 20% of adults take ≥1 obesogenic medication, the proportion in the end-stage kidney disease (ESKD) population-a group enriched for cardiometabolic complications-is unknown. Obesogenic medications may contribute to obesity and hamper weight loss efforts to achieve transplant listing.
Using 2017-2020 USRDS and Medicare claims, patients were identified as taking obesogenic medications if prescribed anticonvulsants, antidepressants, antidiabetics, anti-inflammatories, antipsychotics, and/or antihypertensives known to cause weight gain for ≥30 days in their first hemodialysis year. Ordinal logistic and Cox regression with inverse probability of treatment weighting were used to quantify obesogenic medications' association with body mass index (BMI) and listing, respectively.
Among 271 401 hemodialysis initiates, 63.5% took ≥1 obesogenic medication. For those in underweight, normal weight, overweight, and class I, II, and III categories, 54.3%, 58.4%, 63.1%, 66.5%, 68.6%, and 68.8% took ≥1, respectively. Number of obesogenic medications was associated with increased BMI; use of one was associated with 13% increased odds of higher BMI (aOR [adjusted odds ratio] 1.14; 95%CI: 1.13-1.16; p < 0.001), use of three was associated with a 55% increase (aOR 1.55; 95%CI: 1.53-1.57; p < 0.001). Any use was associated with 6% lower odds of transplant listing (aHR [adjusted hazard ratio] 0.94; 95%CI: 0.92-0.96; p < 0.001). Within each BMI category, obesogenic medication use was associated with lower listing likelihood.
Obesogenic medication use is common in ESKD patients-particularly those with obesity-and is associated with lower listing likelihood. Whenever possible, non-obesogenic alternatives should be chosen for ESKD patients attempting weight loss to achieve transplant listing.
致肥药物被认为是肥胖流行的一个促成因素。虽然有 20%的成年人服用≥1 种致肥药物，但在终末期肾病（ESKD）患者群体中——该群体存在心血管代谢并发症的风险——这一比例尚不清楚。致肥药物可能导致肥胖，并阻碍为获得移植资格而进行的减肥努力。
使用 2017-2020 年美国肾脏数据系统（USRDS）和医疗保险索赔数据，若患者在首次血液透析年内服用已知会导致体重增加≥30 天的抗惊厥药、抗抑郁药、抗糖尿病药、抗炎药、抗精神病药和/或抗高血压药，则将其确定为服用致肥药物。使用逆概率治疗加权的有序逻辑和 Cox 回归来量化致肥药物与体重指数（BMI）和移植资格的相关性。
在 271401 名开始血液透析的患者中，有 63.5%服用了≥1 种致肥药物。对于体重过轻、正常体重、超重以及 I 类、II 类和 III 类患者，分别有 54.3%、58.4%、63.1%、66.5%、68.6%和 68.8%服用了≥1 种致肥药物。服用致肥药物的种类与 BMI 增加相关；使用一种致肥药物会使 BMI 更高的可能性增加 13%（调整后的优势比[aOR]为 1.14；95%CI：1.13-1.16；p<0.001），使用三种致肥药物会使这种可能性增加 55%（aOR 为 1.55；95%CI：1.53-1.57；p<0.001）。任何致肥药物的使用都与移植资格的可能性降低 6%相关（调整后的风险比[aHR]为 0.94；95%CI：0.92-0.96；p<0.001）。在每个 BMI 类别内，致肥药物的使用都与更低的移植资格可能性相关。
致肥药物在 ESKD 患者中很常见——尤其是肥胖患者——并且与更低的移植资格可能性相关。对于试图通过减肥来获得移植资格的 ESKD 患者，应尽可能选择非致肥药物。
