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Gibson CA, Gupta A, Naik A, Sullivan DK, Doshi M, Backes J, Harvey S, Lee J, Mount R, Valentine H, Shaffer K. Developing a Healthy Lifestyle Program for Recent Kidney Transplant Recipients. Prog Transplant 2023; 33:193-200. [PMID: 37469164 DOI: 10.1177/15269248231189878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
INTRODUCTION Many kidney transplant recipients experience weight gain in the first year after transplantation. RESEARCH QUESTION The objective of this research study was to assess the desires of recent kidney transplant patients about the design features of a healthy lifestyle program to counter unnecessary weight gain. DESIGN In this descriptive study, recent recipients at 2 transplant centers were invited to participate in an online survey. Survey items included sociodemographic information, current medications, health conditions, weight change posttransplant, diet behaviors, physical activity participation, and desired features of a lifestyle program. RESULTS Fifty-three participants, mean age 60.5 (11.2) years, primarily males, completed surveys. Forty percent gained weight posttransplantation with many indicating struggling with their diet. Physical activity levels stayed the same (17%) or decreased (40%) posttransplantation. Eighty-seven percent of participants indicated they would participate in an online lifestyle program and 76% wanted online physical activity and nutrition sessions to meet at least once weekly. Suggestions about the type of information and activities, included eating strategies (eg, how to eat healthfully at restaurants, grocery shopping tips, and recipes), resources for at-home physical activities, access to cooking classes, and apps to track both activity and food intake. CONCLUSION Recent kidney transplant recipients would benefit from and desired to join a lifestyle program featuring tailored nutrition education and physical activity coaching. Gathered information will be used to inform and tailor a lifestyle program. Identifying features for the prevention of unnecessary weight gain with patients' input is essential for promoting and sustaining healthy behaviors.
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Affiliation(s)
- Cheryl A Gibson
- Division of General Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Aditi Gupta
- Division of Nephrology, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Abhijit Naik
- Division of Nephrology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Debra K Sullivan
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS, USA
| | - Mona Doshi
- Division of Nephrology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jim Backes
- Department of Pharmacy Practice, University of Kansas Medical Center, Kansas City, KS, USA
| | - Susan Harvey
- Department of Health, Sports, and Exercise Sciences, University of Kansas, Robinson Center, Lawrence, KS, USA
| | - Jaehoon Lee
- Department of Educational Psychology, Leadership, and Counseling, Texas Tech University, Lubbock, TX, USA
| | - Rebecca Mount
- Division of General Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Heather Valentine
- Division of General Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kelly Shaffer
- Division of Nephrology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
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Altheaby A, Alajlan N, Shaheen MF, Abosamah G, Ghallab B, Aldawsari B, Rashidi A, Gafar M, Arabi Z. Weight gain after renal transplant: Incidence, risk factors, and outcomes. PLoS One 2022; 17:e0268044. [PMID: 35653356 PMCID: PMC9162351 DOI: 10.1371/journal.pone.0268044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 04/20/2022] [Indexed: 11/18/2022] Open
Abstract
Background Renal transplantation is the definitive treatment for patients with end-stage renal disease (ESRD). It is associated with better quality of life and patient survival. Nevertheless, these benefits come with rising concerns about weight gain and metabolic abnormalities, which adversely impact transplant outcomes. Objective The objective of this study is to estimate the incidence of weight gain in the first year post-renal transplant in addition to the assessment of potential risk factors and the resulting outcome of the graft. Methods We conducted a single-center retrospective cohort study of all 295 patients who underwent kidney transplantation at King Abdulaziz Medical City (KAMC) between January 2016 and December 2019. Clinical and laboratory variables were collected from electronic records. Continuous variables were reported as mean ± standard deviation. Comparison between groups was assessed by unpaired t-test or Mann-Whitney U test while follow-up data were compared using paired t-test and repeated measures ANOVA. Association between the potential risk factors and the weight gain was assessed by means of binary logistic regression analysis. Results Significant weight gain was observed in 161 (54.6%) patients. Females were 119 (40.30%) of the cohort. The mean age was 45.3±15.1 years. The prevalence of diabetes was 234 (79.6%), while hypertensives constituted 77 (26.3%). The comparison between patients who gained weight significantly and patients with stable weight showed a numerical higher prevalence of female gender in patients who had more weight gain (44.1% vs. 35.8%), higher diabetes, higher rate of a living donor, and statistically significant lower dialysis duration before transplant. Other clinical and laboratory variables were comparable between the two groups. Conclusion Our study showed a high incidence of clinically significant weight gain among patients post-renal transplantation. Patients with lower dialysis duration, a living kidney donor and those who are obese at baseline were at higher risk of gaining weight. Patients who underwent kidney transplantation should be monitored closely for weight gain and further studies are needed to determine the risk factors and appropriate interventions.
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Affiliation(s)
- Abdulrahman Altheaby
- Organ Transplant Center and Hepatobiliary Sciences Department, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- * E-mail:
| | - Nuha Alajlan
- Department of Medicine, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
| | - Mohammed F. Shaheen
- Organ Transplant Center and Hepatobiliary Sciences Department, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ghaleb Abosamah
- Organ Transplant Center and Hepatobiliary Sciences Department, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Basma Ghallab
- Organ Transplant Center and Hepatobiliary Sciences Department, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Basayl Aldawsari
- Organ Transplant Center and Hepatobiliary Sciences Department, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Awatif Rashidi
- Organ Transplant Center and Hepatobiliary Sciences Department, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Mohammed Gafar
- Organ Transplant Center and Hepatobiliary Sciences Department, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Ziad Arabi
- Organ Transplant Center and Hepatobiliary Sciences Department, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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Geneviève M, Sartorius A, Giral M, Janbon B, Merville P, Legendre C, Combe C, Moreau K. Poor kidney graft survival in anorexia nervosa patients. Eat Weight Disord 2021; 26:1447-1455. [PMID: 32666377 DOI: 10.1007/s40519-020-00959-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 07/08/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Anorexia nervosa is a condition associated with poor outcomes in a variety of circumstances such as recurrence of eating disorders, psychiatric disorders, and organ damage. OBJECTIVE In the present study, we first sought to determine the 5-year kidney graft survival in patients with anorexia nervosa and then to evaluate the BMI course and medical complications. METHODS In this multicenter, retrospective, case-control study, we analyzed the impact of anorexia nervosa on graft outcomes compared to transplant recipients with low or normal BMI. RESULTS We enrolled 137 women in this study: 19 with anorexia nervosa, 59 with low BMI (BMI < 18.5 kg/m2), and 59 with normal BMI (18.5-24.9 kg/m2). Anorexia nervosa was significantly associated with lower graft survival compared to either of the other groups (hazard ratio 5.5 [95% CI 3.4-8.9], p = 0.005); there was no difference in graft survival between patients with low or normal BMI. Cardiovascular complications were more frequent in the anorexia nervosa group (37%) than in patients with low (6%) or normal BMI (7%) (p = 0.001). CONCLUSION We conclude that patients with anorexia nervosa should be considered a high-risk group. LEVEL OF EVIDENCE Level III, evidence obtained from well-designed cohort or case-control analytic studies.
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Affiliation(s)
- Magalie Geneviève
- Service de Néphrologie Dialyse, Hôpital Privé Francheville, 4 Place Francheville, 24000, Périgueux, France.
- Service de Néphrologie Transplantation Dialyse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.
| | - Albane Sartorius
- Service de Néphrologie Dialyse Transplantation, Hôpital Foch, Suresnes, France
| | - Magali Giral
- Centre Hospitalier Universitaire de Nantes, Institut Transplantation Urologie Néphrologie, Nantes, France
- Université de Nantes, Nantes, France
| | - Bénédicte Janbon
- Service Néphrologie-Transplantation Rénale-Dialyse, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - Pierre Merville
- Service de Néphrologie Transplantation Dialyse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- Université de Bordeaux, Bordeaux, France
| | - Christophe Legendre
- Service de Néphrologie Dialyse Transplantation, Hôpital Necker, Paris, France
- Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - Christian Combe
- Service de Néphrologie Transplantation Dialyse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- Université de Bordeaux, Bordeaux, France
| | - Karine Moreau
- Service de Néphrologie Transplantation Dialyse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
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Increased Frequency of Nutritional Counseling Improves Weight Status and Lipids in Renal Transplant Recipients. TOP CLIN NUTR 2021. [DOI: 10.1097/tin.0000000000000231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Forte CC, Pedrollo EF, Nicoletto BB, Lopes JB, Manfro RC, Souza GC, Leitão CB. Risk factors associated with weight gain after kidney transplantation: A cohort study. PLoS One 2020; 15:e0243394. [PMID: 33370293 PMCID: PMC7769456 DOI: 10.1371/journal.pone.0243394] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 11/19/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Renal transplantation is the best modality of renal replacement therapy for patients with end-stage renal disease. However, it is associated with weight gain and metabolic abnormalities, which adversely impact transplant outcomes. OBJECTIVE The objective of this study was to identify the risk factors of one-year weight gain after renal transplantation. METHODS A retrospective cohort study was conducted with 374 patients that underwent kidney transplantation between January 2006 and July 2013. Clinical and laboratory variables were collected from electronic records, and the outcome of interest was weight gain during the first year after renal transplantation. The data were reported as mean ± standard deviation, median (interquartile range) or number of subjects (%). The association between variables were assessed via chi-square test and ANOVA. For analysis of risk factors related to the outcomes of interest, multivariable logistic regression models were used. RESULTS There were 181 (48.4%) female patients, 334 (89.3%) with white ethnicity and the mean age was 44.4 ± 12.8 years. The mean BMI pre-transplant was 24.7 ± 4.1 kg/m2, and 35 (9.9%) patients were classified as obese; 119 (33.6%) as overweight; 187 (52.8%) as normal weight; and 13 (3.7%) as malnourished. After one year of follow-up, the mean BMI was 26.2 ± 5.0 kg/m2, and 61 (17.3%) patients were classified as obese; 133 (37.8%) as overweight; 148 (42.0%) as normal weight; and 10 (2.8%) as malnourished. Weight gain was observed in 72.7% patients, and the average increase was 7.12 ± 5.9 kg. The female gender, lower pre-transplant body weight, lower number of hospitalizations, and a kidney received from a living donor were associated with weight gain by more than 5% in the first year post-transplant. CONCLUSION Female gender and lower pre-transplant body weight were independently associated with weight gain by more than 5% in the first year after kidney transplantation; lower rates of hospitalization and donation from living donors were also risk factors for this outcome.
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Affiliation(s)
- Cristina Carra Forte
- Post-graduate Program in Medical Sciences: Endocrinology, School of Medicine, Universidade Federal do Rio Grande do Sul Faculdade de Medicina, Porto Alegre, Brazil
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Elis Forcellini Pedrollo
- Post-graduate Program in Medical Sciences: Endocrinology, School of Medicine, Universidade Federal do Rio Grande do Sul Faculdade de Medicina, Porto Alegre, Brazil
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Bruna Bellincanta Nicoletto
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Life Science Knowledge Area, Universidade de Caxias do Sul, Caxias do Sul, Brazil
| | - Jéssica Blatt Lopes
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Nutrition Graduate Course, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Roberto Ceratti Manfro
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Post-graduate in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Division of Nephrology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Gabriela Corrêa Souza
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Division of Nutrition, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Cristiane Bauermann Leitão
- Post-graduate Program in Medical Sciences: Endocrinology, School of Medicine, Universidade Federal do Rio Grande do Sul Faculdade de Medicina, Porto Alegre, Brazil
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Navaratnarajah A, El-Sherbini N, Brown EA. Long-term outcomes in patients with encapsulating peritoneal sclerosis managed with nutritional support. ARCH ESP UROL 2020; 40:487-495. [PMID: 32067553 DOI: 10.1177/0896860819893565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Little is known about long-term survivors with encapsulating peritoneal sclerosis (EPS). Published literature focuses on patients managed surgically. We describe our experience of the long-term outcomes in patients with EPS conservatively managed with nutritional support alone. METHODS This is a single-centre retrospective observational study of patients who had survived for ≥5 years since diagnosis. EPS survivors were invited for review of symptoms, nutritional assessment and evaluation of quality of life. Radiological progression was assessed based on serial computed tomography (CT) scores for each patient. RESULTS A total of 23 patients with a diagnosis of EPS for at least 5 years were identified, with 18 patients alive at the time of the study. Of these 18 patients, 10 patients transferred to haemodialysis (HD) and 8 patients received kidney transplants. Commonest symptoms were nausea (91%) and vomiting (73%). Mean body mass index for patients was within the ideal and healthy range, with only 11% suffering from continued weight loss. In all, 70% EPS survivors on HD received nutritional support compared to 15% of those with transplants; 17% required ongoing parenteral nutrition. Of the 11 patients with serial CT scans at least 4 years apart, 10 had an increase in radiological score for EPS but with no apparent correlation to clinical outcomes. There were no significant differences in the reported quality of life between EPS survivors on HD and those transplanted, with self-rated health status equivalent to that reported for the general end-stage kidney disease (ESKD) population. CONCLUSION Long-term survival following EPS managed conservatively with nutritional support is feasible, with the majority no longer requiring nutritional support and having a quality of life similar to other patients with ESKD.
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Affiliation(s)
- Arunraj Navaratnarajah
- Imperial College Renal and Transplant Centre, 8946Imperial College Healthcare NHS Trust, London, UK
| | - Nevine El-Sherbini
- Imperial College Renal and Transplant Centre, 8946Imperial College Healthcare NHS Trust, London, UK
| | - Edwina A Brown
- Imperial College Renal and Transplant Centre, 8946Imperial College Healthcare NHS Trust, London, UK
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Majoni SW, Ullah S, Collett J, Hughes JT, McDonald S. Weight change trajectories in Aboriginal and Torres Strait islander Australians after kidney transplantation: a cohort analysis using the Australia and New Zealand Dialysis and Transplant registry (ANZDATA). BMC Nephrol 2019; 20:232. [PMID: 31238893 PMCID: PMC6593536 DOI: 10.1186/s12882-019-1411-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 06/06/2019] [Indexed: 11/17/2022] Open
Abstract
Background Weight change post-kidney transplantation and its associations in Aboriginal and Torres Strait Islander Australians, a group known to have poor patient and graft outcomes, are unknown. Weight change based on body mass index in Aboriginal and Torres Strait Islander Australian recipients was compared to non- indigenous recipients. Methods We performed a cohort analysis of data from the Australia and New Zealand Dialysis and Transplant Registry for first deceased donor kidney transplant recipients between 1995 and 2014 in Australia. Weight change post-kidney transplantation was analysed by recipient ethnicity using multivariate mixed effect linear regression analysis. Results There were 343 (5.24%) Aboriginal and Torres Strait Islander Australian kidney transplants recipients from a total of 6550 recipients. They had higher pre-transplant BMI (p < 0.001), higher rates of current smokers (p < 0.001), diabetes (p < 0.001), coronary artery disease (p < 0.001), cerebrovascular disease (p = 0.011) and peripheral vascular disease (p = 0.013), ≥4 HLA mismatches (p < 0.001), graft loss (p < 0.001), mortality (p < 0.001) and rejection rates (p < 0.001). Weight increased in the first 2 years post-transplantation in both Aboriginal and Torres Strait Islander Australians and non-indigenous Australians. After adjusting for the baseline differences, weight change diverged significantly at 6, 12 and 24 months. The difference was most marked between 6 and 12 months. When stratified by pre-transplantation BMI, all groups except underweight reflected this pattern. Normal weight and obese Aboriginal and Torres Strait Islander Australian recipients had substantial increase at 12 and 24 months and overweight at 6, 12 and 24 months. The difference in BMI trajectories between Aboriginal and Torres Strait Islander Australians and non- indigenous Australian transplant recipients persisted after adjustment in multivariate mixed effect linear regression analysis. Conclusions Post-kidney transplantation weight gain in this high-risk population is substantial and greater than in non-indigenous Australians. Further studies should assess the effect of treatment factors and weight gain on transplant and recipient outcomes.
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Affiliation(s)
- Sandawana William Majoni
- Department of Nephrology, Division of Medicine, Royal Darwin Hospital, P.O. Box 41326, Casuarina, Darwin, Northern Territory, Australia. .,Flinders University and Northern Territory Clinical School, Royal Darwin Hospital Campus, Darwin, Australia. .,Menzies School of Health Research Charles Darwin University, Darwin, NT, Australia.
| | - Shahid Ullah
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, SA Health and Medical Research Institute, Adelaide, Australia.,Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - James Collett
- Department of Nephrology, Division of Medicine, Royal Darwin Hospital, P.O. Box 41326, Casuarina, Darwin, Northern Territory, Australia
| | - Jaquelyne T Hughes
- Department of Nephrology, Division of Medicine, Royal Darwin Hospital, P.O. Box 41326, Casuarina, Darwin, Northern Territory, Australia.,Menzies School of Health Research Charles Darwin University, Darwin, NT, Australia
| | - Stephen McDonald
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, SA Health and Medical Research Institute, Adelaide, Australia.,Central Northern Adelaide Renal and Transplantation Services, Royal Adelaide Hospital, Adelaide, Australia.,Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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Klaassen G, Zelle DM, Navis GJ, Dijkema D, Bemelman FJ, Bakker SJ, Corpeleijn E. Lifestyle intervention to improve quality of life and prevent weight gain after renal transplantation: Design of the Active Care after Transplantation (ACT) randomized controlled trial. BMC Nephrol 2017; 18:296. [PMID: 28915863 PMCID: PMC5599936 DOI: 10.1186/s12882-017-0709-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 08/30/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Low physical activity and reduced physical functioning are common after renal transplantation, resulting in a reduced quality of life. Another common post-transplantation complication is poor cardio-metabolic health, which plays a main role in long-term outcomes in renal transplant recipients (RTR). It is increasingly recognized that weight gain in the first year after transplantation, especially an increase in fat mass, is a highly common contributor to cardio-metabolic risk. The aim of this study is to compare the outcomes of usual care to the effects of exercise alone, and exercise combined with dietary counseling, on physical functioning, quality of life and post-transplantation weight gain in RTR. METHODS The Active Care after Transplantation study is a multicenter randomized controlled trial with three arms in which RTR from 3 Dutch hospitals are randomized within the first year after transplantation to usual care, to exercise intervention (3 months supervised exercise 2 times per week followed by 12 months active follow-up), or to an exercise + diet intervention, consisting of the exercise training with additional dietary counseling (12 sessions over 15 months by a renal dietician). In total, 219 participants (73 per group) will be recruited. The primary outcome is the subdomain physical functioning of quality of life, (SF-36 PF). Secondary outcomes include other evaluations of quality of life (SF-36, KDQOL-SF, EQ-5D), objective measures of physical functioning (aerobic capacity and muscle strength), level of physical activity, gain in adiposity (body fat percentage by bio-electrical impedance assessment, BMI, waist circumference), and cardiometabolic risk factors (blood pressure, lipids, glucose metabolism). Furthermore, data on renal function, medical history, medication, psychological factors (motivation, kinesiophobia, coping style), nutrition knowledge, nutrition intake, nutrition status, fatigue, work participation, process evaluation and cost-effectiveness are collected. DISCUSSION Evidence on the effectiveness of an exercise intervention, or an exercise + diet intervention on physical functioning, weight gain and cardiometabolic health in RTR is currently lacking. The outcomes of the present study may help to guide future evidence-based lifestyle care after renal transplantation. TRIAL REGISTRATION Number: NCT01047410 .
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Affiliation(s)
- Gerald Klaassen
- Department of Internal Medicine, division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Dorien M. Zelle
- Department of Internal Medicine, division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Gerjan J. Navis
- Department of Internal Medicine, division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Desie Dijkema
- Department of Dietetics, University Medical Center Groningen, Groningen, the Netherlands
| | - Frederike J. Bemelman
- Department of Nephrology, Amsterdam Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Stephan J.L. Bakker
- Department of Internal Medicine, division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Eva Corpeleijn
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Abstract
BACKGROUND AND AIM Associations between pre-liver transplantation (pre-LT) BMI and post-LT survival are well described; however, there are few data assessing the associations between the commonly observed post-LT BMI changes and survival. We investigated the impact of early post-LT BMI change on post-LT patient and graft survival. METHODS Using United Network for Organ Sharing data, we identified 2968 adult primary LT recipients who were not overweight pre-LT (BMI >16 to ≤25 kg/m), and who had BMI recorded at 2 years post-LT. Delta BMI was defined as the BMI difference between pre-LT and 2 years post LT. Recipients were grouped into three categories: BMI gain (increase by >1 BMI point), BMI loss (decrease by >1 BMI point), and BMI stable (maintained BMI within 1 point). Associations between delta BMI and patient and graft survival were evaluated using Kaplan-Meier and multivariable Cox regression analyses. RESULTS BMI gain was common (54%) and associated with significantly greater 5-year patient and graft survival (90 and 89%, respectively), compared with recipients who had either BMI loss (77 and 74%, respectively, P<0.0001 for both) or were BMI stable (83%, P=0.04 and 82%, P=0.007, respectively). In multivariable analyses, increasing delta BMI was found to be inversely associated with risk for death and graft loss [hazard ratio 0.89 (95% confidence interval 0.86-0.91), P<0.001; and hazard ratio 0.88 (95% confidence interval 0.86-0.91), P<0.001, respectively]. CONCLUSION This study of a large national liver transplant database demonstrated that post-LT BMI gain was associated with better patient and graft survival, whereas BMI loss was associated with reduced patient and graft survival.
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de Oliveira C, Moura Á, Gonçalves L, Pinheiro L, Pinheiro F, Esmeraldo R. Post-Transplantation Weight Gain: Prevalence and the Impact of Steroid-Free Therapy. Transplant Proc 2014; 46:1735-40. [DOI: 10.1016/j.transproceed.2014.05.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Orazio L, Chapman J, Isbel NM, Campbell KL. Nutrition care for renal transplant recipients: an evaluation of service delivery and outcomes. J Ren Care 2014; 40:99-106. [PMID: 24641300 DOI: 10.1111/jorc.12055] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Weight gain post-renal transplantation is common. Recommendations from recent guidelines include providing structured nutrition care to target risk factors for chronic disease in the early post-transplant period. OBJECTIVES This study aimed to evaluate the nutrition care provided to renal transplant recipients following implementation of a dietetic model of care and to identify predictors of weight change up to one year post-transplant. METHODS A retrospective and observational study of one hundred and fifty-six patients that received a renal transplant from a state-wide transplant service in Australia between October 2009 and December 2010. Nutrition care provided compared with guideline recommendations within the first three months post-transplant and weight change at 12 months post-transplant, significant weight gain equating to >5% pre-transplant weight. RESULTS Only 35% of patients were provided with nutrition care according to guideline recommendations, were older, and had a higher BMI and diabetes. Significant weight gain was evident for half of the patients evaluated. Thirty-eight percent of healthy weight patients at transplant became overweight or obese and 23% of overweight patients at baseline became obese at 12 months. After multivariate analysis, time on dialysis was independently associated with weight change at 12 months. CONCLUSION Nutrition care provided did not meet guideline recommendations, highlighting difficulty in implementing evidence to practice. Significant weight gain was evident particularly in patients classified as 'healthy weight' at the time of transplant. Long-term, prospective studies are needed to determine the effectiveness of implementing nutrition care to attenuate weight gain and improve clinical outcomes.
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Affiliation(s)
- Linda Orazio
- Department of Nutrition and Dietetics, Princess Alexandra Hospital and School of Medicine, University of Queensland, Brisbane, Queensland, Australia; Department of Nephrology, Princess Alexandra Hospital and School of Medicine, University of Queensland, Brisbane, Queensland, Australia
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Kim Y, Kim JR, Choi H, Hwang JW, Jang HR, Lee JE, Kim SJ, Kim YG, Kim DJ, Oh HY, Huh W. Patients with persistent new-onset diabetes after transplantation have greater weight gain after kidney transplantation. J Korean Med Sci 2013; 28:1431-4. [PMID: 24133345 PMCID: PMC3792595 DOI: 10.3346/jkms.2013.28.10.1431] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 08/19/2013] [Indexed: 11/20/2022] Open
Abstract
The purpose of the present study was to evaluate the difference in BMI pattern between patients with persistent new-onset diabetes after transplantation (P-NODAT) and without new-onset diabetes after transplantation (N-NODAT) in a retrospective matched case-control (1:3) analysis. Thirty-six patients who developed P-NODAT were identified among 186 adult renal transplant recipients with no evidence of pretransplant diabetes mellitus who underwent kidney transplantation from September 1997 to March 2008 and were treated with a triple regimen including tacrolimus. The controls were selected to match the patients for pretransplant BMI, age at transplantation (± 5 yr), and date of transplantation (± 12 months). Finally, 20 P-NODAT patients and 60 N-NODAT patients were selected. The pre- and posttransplant BMI data were collected every 16 weeks for up to 80 weeks. The clinical characteristics did not differ between the P-NODAT group and N-NODAT group. BMI increased faster in the P-NODAT group than in the N-NODAT group. The mixed-model analysis showed that patients with P-NODAT exhibited a faster increase in BMI. P-NODAT is associated with posttransplant weight gain. The risk of P-NODAT should be considered in patients with rapid weight gain after transplantation.
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Affiliation(s)
- Yoonjung Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Ryul Kim
- Department of Clinical Pharmacology and Therapeutics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Heejung Choi
- Department of Medicine, Konkuk University Chungju Hospital, Chungju, Korea
| | - Jung-won Hwang
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hye Ryoun Jang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Eun Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung-Joo Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon-Goo Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dae Joong Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ha Young Oh
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wooseong Huh
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Clinical Pharmacology and Therapeutics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Boschetti SB, Nogueira PCK, Pereira AML, Fisberg M, Pestana JOM. Prevalence, risk factors, and consequences of overweight in children and adolescents who underwent renal transplantation--short- and medium-term analysis. Pediatr Transplant 2013; 17:41-7. [PMID: 23170966 DOI: 10.1111/petr.12020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/01/2012] [Indexed: 02/03/2023]
Abstract
UNLABELLED To determine the prevalence and risk factors for (i) overweight/obesity and (ii) weight gain six months after transplantation and to study the effect of weight excess on graft function and survival. We performed a retrospective study of kidney transplanted children. ENDPOINTS (i) prevalence of overweight/obesity at sixth month, (ii) gaining 1.0 BMI SDS from one to six months. To study the effects of weight excess, graft function and survival at 36 months were the endpoints. The study included 197 individuals. At sixth month, 57/197 (29%) presented overweight/obesity, and the factors associated to this outcome were: (i) age at transplantation (OR = 3.04) and (ii) overweight/obesity in the first month (OR = 22.16). Groups presented no difference on graft function and survival at 36 months. From one to six months, 90/197 (46%) patients gained >1.0 BMI SDS. This outcome was associated with (i) female sex (OR = 2.50), (ii) steroids' pulses (OR = 2.98), (iii) steroids exposure (OR = 1.04), and (iv) living donor (OR = 2.69). The group that gained BMI presented a lower 36 months graft survival (86% vs. 98%, p < 0.001). Weight excess and gain after transplantation are frequent, particularly in younger female recipients and in those receiving high steroids exposure. The lower graft survival in patients with rapid weight gain deserves investigation.
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Affiliation(s)
- Sofia Bonna Boschetti
- Pediatrics Department, Universidade Federal de São Paulo - Escola Paulista de Medicina, Sao Paulo, Brazil
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Abstract
BACKGROUND There are few studies on the associations of postkidney transplant weight change on survival. Weight change in different posttransplant periods may have different causes and implications. We used the Australian and New Zealand Dialysis and Transplant Registry data to examine these issues. METHODS All adult white primary kidney transplant recipients from April 1991 to December 2004 were included. The associations of first (year 1, n=3899) and second (year 2, n=3419) year weight change with subsequent graft and patient survival were analyzed using multivariable Cox regression. RESULTS Weight gain 10% to 19.9% in year 1 and stable weight (0%-4.9% gain) in year 2 were associated with the best outcomes. Weight loss more than 5% was associated with subsequent death (year 1 adjusted hazard ratio [aHR]=1.64 [1.08-2.48], P=0.019; year 2 aHR=2.09 [1.44-3.02], P=0.013) but not death-censored graft loss. Weight gain more than or equal to 20% in year 1 and more than or equal to 10% weight gain in year 2 were also associated with subsequent death (year 1 aHR=1.78 [1.13-2.81], P=0.013; year 2 aHR=1.67 [1.01-2.76], P=0.047). These associations were minimally changed by excluding outcomes within 1 year of the weight change. Deaths were from cardiovascular disease (35%), cancer (35%), infections (15%), and "other" causes (15%). Weight gain more than or equal to 20% in year 1 was associated with infection or "other" deaths, and weight loss more than 5% or weight gain more than or equal to 10% in year 2 with cardiovascular deaths. CONCLUSIONS Significant posttransplant weight gain or loss was associated with poorer transplant outcomes. Reasons underlying these associations may differ between year 1 and year 2 weight changes.
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Ersoy A, Baran B, Ersoy C, Kahvecioglu S, Akdag I. Calcineurin inhibitors and post-transplant weight gain. Nephrology (Carlton) 2008; 13:433-9. [PMID: 18331443 DOI: 10.1111/j.1440-1797.2008.00916.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIM Excessive weight gain that leads to obesity is quite common after kidney transplantation. This is often attributed to immunosuppression. The aim of this retrospective study was to assess the effect of calcineurin inhibitors on post-transplant weight gain. METHODS A total of 99 patients were studied. The patients were divided into cyclosporine A (CyA) and tacrolimus (Tac) groups and were evaluated for weight changes and risk factors related to weight gain. RESULTS The weights of patients in both groups significantly increased after the sixth month. The median weight gain at 12 months was 3.5 and 8.0 kg compared with pretransplant dry weight in the Tac and CyA groups, respectively. The increases in the CyA group were significant compared with those of the Tac group. The prevalences of obese and overweight patients in both groups did not differ during a 12-month follow-up. The frequencies of diabetes mellitus, hypertension and dyslipidemia were comparable in both groups. The decrease in systolic blood pressure (BP) of the Tac group was significant compared with the decrease in the CyA group at the 12th month. In the 12-month follow-up period, the increases in triglyceride, total- and low-density lipoprotein-cholesterol values of the CyA group were significantly higher than those of the Tac group. The weight change between 0 and 12 months was negatively correlated with pretransplant body mass index (BMI) and positively with cumulative corticosteroid doses, total-cholesterol and BP changes. CONCLUSION Only pretransplant BMI, creatinine clearance, CyA usage, being hypertensive and dyslipidemic were independent predictors of weight gain at the 12th month. Our results suggested that the type of immunosuppression may affect post-transplant weight gain.
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Affiliation(s)
- Alpaslan Ersoy
- Department of Nephrology, Uludag University Medical School, Bursa, Turkey.
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Torres MRSG, Motta EM, Souza FCM, Guimarães SSMS, Souza E, Silva MIB. Weight Gain Post–Renal Transplantation and Its Association With Glomerular Filtration Rate. Transplant Proc 2007; 39:443-5. [PMID: 17362754 DOI: 10.1016/j.transproceed.2007.01.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Obesity may be a risk factor for renal graft loss. The purpose of this study was to assess weight gain and its association with glomerular filtration rate after kidney transplant. METHODS This retrospective analysis of 152 adult renal transplant outpatients (77 males, 75 females; mean age, 45.6 +/- 10.1 years) with at least 6 months posttransplantation (post-tx) included body weight and creatinine clearance (CrCl) measured pretransplantation (pre-tx) as well as at 6 months (post-tx1), 1 year (post-tx2), 5 years (post-tx3), 10 years (post-tx4), 15 years (post-tx5), and 20 years (post-tx6) post-tx. Weight gain was determined by subtracting patient preoperative weight from the post-tx weights. RESULTS The weight gain post-tx versus pre-tx was progressive and significant (P < .001) post-tx1, 8.7 +/- 10.9% (n = 152); post-tx2, 12.4 +/- 11.5% (n = 150); post-tx3, 16.6 +/- 14.8% (n = 102); post-tx4, 20.1 +/- 18.1% (n = 47); post-tx5, 20.8 +/- 19.8% (n = 17); and post-tx6, 21.0 +/- 32.5% (n = 11). There was a positive and significant correlation between weight gain and CrCl during most times post-tx: post-tx2 (r = 0.32; P < .000); post-tx3 (r = 0.54; P < .0001); post-tx4 (r = 0.47; P = .01); and post-tx6 (r = 0.92; P < .001). CONCLUSIONS There was a great increase in body weight after kidney transplantation. The excessive body weight gain was associated with a better glomerular filtration rate.
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Affiliation(s)
- M R S G Torres
- Nutrition Division, Rio de Janeiro State University, Rio de Janeiro, Brazil.
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