Introduction: 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.
Methods:  Using 2017-2019 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 BMI and listing, respectively.
Results: Among 271,401 hemodialysis initiates, 55.8% took >=1 obesogenic medication. For those with underweight, normal weight, overweight, and class I, II, and III obesity, 51.5%, 53.2%, 55.8%, 57.3%, 58.3%, and 58.5% took >=1. Number of obesogenic medications was monotonically associated with increased BMI; use of one was associated with 3% increased odds of higher BMI (aOR 1.03; 95%CI: 1.02-1.05; P<0.001), use of four was associated with an 18% increase (aOR 1.18; 95%CI: 1.17-1.20; P<0.001).
 
Any use was associated with 9% lower odds of transplant listing (aHR 0.91; 95%CI: 0.89-0.93; P<0.001). Within each BMI category, obesogenic medication use was associated with lower listing likelihood. 
Conclusions:  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.