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Lipid abnormalities in pediatric kidney transplant recipients on steroid withdrawal maintenance immunosuppression

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Abstract

Background

Dyslipidemia is a modifiable risk factor for cardiovascular disease. The prevalence of dyslipidemia in pKTR (pediatric kidney transplant recipients) under modern immunosuppression remains unknown. We determined the prevalence, risk factors, co-morbidities, and treatment patterns of lipid abnormalities in pediatric kidney transplant recipients on steroid withdrawal immunosuppression.

Methods

pKTR (age ≤ 21 years) at a single center on steroid withdrawal immunosuppression underwent lipid screening between January 1, 2020, and September 30, 2022. Continuous and categorical variables were compared using the Wilcoxon rank-sum and chi-square or Fisher’s exact tests, respectively. The correlation between total cholesterol and BMI (body mass index) was assessed using Pearson’s product–moment correlation, and predictors of lipid abnormalities were evaluated using the multivariable logistic regression.

Results

A total of 96 patients were included, with a median post-transplant time of 2.5 years (IQR: 1.3–5.4). Of the total, 64.6% (n = 62) of patients had a fasting lipid abnormality. We found a significant linear correlation between total cholesterol and BMI (r = 0.38, p = 0.0022). After multivariable adjustment, every 1 ml/min/1.73 m2 increase in eGFR was associated with a 2% lower odds of a lipid abnormality (OR 0.979, p = 0.026). Obesity, hypertension, and left ventricular hypertrophy were similar between those with and without lipid abnormalities, while insulin-treated diabetes was more prevalent in recipients with lipid abnormalities (12.9% vs. 0%, p = 0.047). Only 36.5% of patients (n = 19) were referred to a dietician and/or lipid specialist; one received statin therapy.

Conclusions

Lipid abnormalities are highly prevalent in pKTR, but therapeutic intervention is infrequent. Calcineurin inhibition without corticosteroids may not be protective; however, higher eGFR is associated with a lower prevalence of lipid abnormalities.

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Data availability

Data are available upon request to the corresponding author.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Nephrology, University of Minnesota, Academic Office Building, 2450 Riverside Ave S AO-201, Minneapolis, MN, 55454, USA

    Emily Zangla, Ruchi Mahajan & Sarah J. Kizilbash

  2. Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA

    Ziou Jiang

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  1. Emily Zangla
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  2. Ruchi Mahajan
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Zangla, E., Mahajan, R., Jiang, Z. et al. Lipid abnormalities in pediatric kidney transplant recipients on steroid withdrawal maintenance immunosuppression. Pediatr Nephrol 39, 261–268 (2024). https://doi.org/10.1007/s00467-023-06110-w

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