#2652 How are people living with obesity and kidney failure supported to lose weight prior to kidney transplantation?: a national survey of kidney healthcare providers in the United Kingdom

Abstract Background and Aims Obesity affects 28% of adults in the United Kingdom (UK) and is associated with chronic kidney disease progression and kidney failure (KF) requiring kidney replacement therapy. Obesity can preclude access to kidney transplant, however pathways to access NHS weight loss (obesity) management services remain inconsistent. The study aimed to explore UK healthcare professionals’ (HCP) perspectives on how people living with obesity and KF on haemodialysis prior to kidney transplantation are supported with weight loss management to become eligible for transplantation. Methods A prospective national UK cross-sectional survey was conducted between July and December 2024. The survey was conducted online, using purposive and snowball sampling. The survey used closed-ended questions to explore areas regarding weight loss management including if patients wanted to lose weight, weight loss advice given, access to supporting obesity services and local transplantation listing criteria. Results The majority of UK kidney centres responded (86%), with 228 HCP respondents, including dietitians (34%), nephrologists (22%) and nurses (21%). Mean age (± standard deviation) was 44.6 ± 10.5 years; of which 78% were female; 82% were white ethnicity and 67% were based in England, 14% in Scotland, 10% in Northern Ireland and 8% in Wales. HCP reported 95% of patients wished to lose weight, with kidney transplant being the main reason (93%) followed by improved mobility (61%) and self-esteem/body image (61%). The greatest challenges to weight loss were reported as lack of access to obesity management services for referral (61%), long waiting list for obesity management services (60%) and lack of funding or investment in obesity (58%). HCPs reported 60% had access to an obesity service, with the majority being external to their kidney service (87%). Weight loss advice focussed on healthy eating (85%) and increasing physical activity (70%), with dietitians (90%) being the main HCP providing this care. In terms of the other weight loss interventions, 39% reported referring patients for bariatric surgery services and 35% referred people for medications for obesity. When asked about referral criteria to list patients for kidney transplant at their kidney centre, 67% knew what these local criteria were. Of those that knew the criteria, the majority reported using either body mass index cut-offs (BMI, 54%) or individualising the criteria to the patient (23%), while 7% had no BMI limit or cut off. Other measures of adiposity were rarely used (1% waist circumference or 3% waist to height ratio). Conclusions This is the first UK national survey demonstrating inconsistent access to obesity services to help support weight loss, which were further hindered by long waiting times. Most patients expressed wishing to lose weight, primarily to gain access to transplantation, though other important reasons were identified, which should be considered by HCPs. Management tended to focus on nutrition and physical activity and lacked escalation to other effective interventions. Our data reveals a lack of consensus regarding listing criteria for kidney transplantation regarding obesity, with strict BMI cutoffs being used in some centres, which has the potential to impact transplant accessibility for people living with obesity and KF. Our findings suggest there is an urgent need to develop national guidelines regarding kidney transplant waitlisting criteria, with greater access to obesity interventions to help patients meet their healthcare goals and ensure equitable access to transplantation.