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Body fat predicts urinary tract infection in kidney transplant recipients: a prospective cohort study

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Abstract

Background

The association between obesity and infectious diseases is increasingly reported in the literature. There are scarce studies on the association between obesity and urinary tract infection after kidney transplantation (KTx). These studies defined obesity based on body mass index, and their results were conflicting. The present study aimed to evaluate this association using bioelectrical impedance analysis for body composition evaluation, and obesity definition.

Methods

A single-center cohort study was conducted. Demographic, clinical, anthropometric, and laboratory data were collected at KTx admission, and bioelectrical impedance analysis was performed to measure the visceral fat area, waist circumference, and total fat mass. The occurrence of urinary tract infection (symptomatic bacteriuria and/or histological evidence of pyelonephritis) was evaluated within three months after KTx.

Results

Seventy-seven patients were included in the cohort, and 67 were included in the final analysis. Urinary tract infection was diagnosed in 23.9% of the transplanted patients. Waist circumference (HR: 1.053; 95% CI 1.005–1.104; p = 0.032), visceral fat area (HR: 1.015; 95% CI 1.003–1.027; p = 0.014), and total fat mass (HR: 1.075; 95% CI 1.008–1.146; p = 0.028) were associated with urinary tract infection occurrence after KTx, using Cox regression models. Patients with high waist circumference (above 102 cm for men and above 88 cm for women) had a 4.7 times higher risk of a urinary tract infection than those with normal waist circumference (HR: 4.726; 95% CI 1.267–17.630; p = 0.021). Kaplan–Meier curves showed that patients with high waist circumference, high visceral fat area, and high total fat mass had more urinary tract infections (Log-rank test p = 0.014, p = 0.020, and p = 0.018, respectively). Body mass index was not able to predict urinary tract infection in the study sample.

Conclusions

Waist circumference, visceral fat area, and total fat mass, assessed by bioelectrical impedance analysis, were predictors of urinary tract infection risk within the first three months after KTx.

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Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

This work was supported by the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) (grant number: 2016/24745–3) and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-Brasil (CAPES)—Finance Code 001. Thomáz Eduardo Archangelo received a scientific initiation scholarship from the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), RT—Bolsa Reitoria, project number 42014. Nyara Coelho de Carvalho received a scientific initiation scholarship from the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), RT—Bolsa Reitoria, project number 51408.

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Authors and Affiliations

  1. Medical School, São Paulo State University (Unesp), Botucatu, São Paulo, Brazil

    Thaysa Sobral Antonelli, Milena dos Santos Mantovani, Nyara Coelho de Carvalho & Thomáz Eduardo Archangelo

  2. Internal Medicine Department, Medical School, São Paulo State University (Unesp), Botucatu, São Paulo, Brazil

    Marcos Ferreira Minicucci & Luis Gustavo Modelli de Andrade

  3. Department of Infectious Diseases, Dermatology, Imaging Diagnosis, and Radiotherapy, Medical School, São Paulo State University (Unesp), Av. Prof. Mário Rubens Guimarães Montenegro, s/n, UNESP, Campus de Botucatu, Botucatu, SP, CEP 18618-687, Brazil

    Sebastião Pires Ferreira Filho, Ricardo de Souza Cavalcante, Gabriel Berg de Almeida & Ricardo Augusto Monteiro de Barros Almeida

  4. Faculty of Nutrition, Universidade Federal de Goiás (UFG), Goiânia, Brazil

    Nara Aline Costa

  5. Division of Urology, Department of Surgical Specialties and Anesthesia, Medical School, São Paulo State University (Unesp), Botucatu, São Paulo, Brazil

    Paulo Roberto Kawano

  6. Department of Nursing, Medical School, São Paulo State University (Unesp), Botucatu, São Paulo, Brazil

    Silvia Justina Papini

Authors
  1. Thaysa Sobral Antonelli
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  2. Milena dos Santos Mantovani
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Contributions

TSA: Conceptualization, Data curation, Investigation, Writing—Review & Editing MSM: Conceptualization, Data curation, Investigation, Writing—Review & Editing NCC: Investigation, Writing—Review & Editing TEA: Investigation, Writing—Review & Editing MFM: Conceptualization, Formal analysis, Data curation, Writing—Review & Editing SPFF: Conceptualization, Investigation, Writing—Review & Editing RSC: Conceptualization, Investigation, Writing—Review & Editing LGMA: Conceptualization, Writing—Review & Editing NAC: Conceptualization, Writing—Review & Editing PRK: Investigation, Writing—Review & Editing GBA: Conceptualization, Writing—Original Draft, Writing—Review & Editing SJP: Conceptualization, Writing—Review & Editing RAMBA: Conceptualization, Data curation, Investigation, Writing—Review & Editing, Project administration, Funding acquisition.

Corresponding author

Correspondence to Ricardo Augusto Monteiro de Barros Almeida.

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Conflict of interest

The authors of this study declare no conflict of interest.

Ethical approval

The research project was approved by the Research Ethics Committee of the Botucatu Medical School—UNESP (CAAE: 59232316.2.0000.5411). The work was carried out following the Declaration of Helsinki for experiments involving humans.

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All procedures were approved by the Botucatu Medical School, São Paulo State University, Institutional Review Board.

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All participants provided written informed consent.

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Antonelli, T.S., Mantovani, M.d., Carvalho, N.C. et al. Body fat predicts urinary tract infection in kidney transplant recipients: a prospective cohort study. J Nephrol (2024). https://doi.org/10.1007/s40620-024-01922-x

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