1
|
Selçuk Topbaş S, Sarıgöl Ordin Y. Investigation of Weight Gain and Affecting Factors in Kidney Transplant Recipients in the First 2 Years After Transplant. EXP CLIN TRANSPLANT 2024; 22:200-206. [PMID: 35607798 DOI: 10.6002/ect.2022.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES It is necessary to examine weight gain and affecting factors after kidney transplant. This study was performed to examine weight gain and affecting factors in kidney transplant recipients in the first 2 years after transplant. MATERIALS AND METHODS This descriptive cross-sectional study included 139 kidney transplant recipients who were regularly followed by 2 university hospitals in the first 2 years after transplant. Data were collected with the use of a sociodemographic and clinical features' form and the General Self-Efficacy Scale. Weight and body mass index at 3, 6, 12, and 24 months after transplant were evaluated. Differences between weight (in kilograms) and body mass index (in kilograms divided by height in meters squared) at the first outpatient clinic visit and weight and body mass index at 24 months after transplant were calculated. RESULTS The mean age of patients was 46.32 ± 12.39 years. Differences in mean weight and body mass index between the first posttransplant outpatient clinic visit and at month 24 posttransplant were 7.07 ± 7.57 and 2.6 ± 2.37, respectively. Statistically significant differences were found in weight and body mass index at 2 years posttransplant. As age increased, weight gain decreased. Differences in weight gain and body mass index were not significantly associated with sex, presence of chronic diseases, donor type, steroid dose, and self-efficacy. CONCLUSIONS Kidney transplant recipients in our study population had increased weight and body mass index at 2 years after transplant. Younger kidney transplant recipients had higher weight gains. Therefore, kidney transplant recipients, especially younger ones, should be closely followed in terms of weight gain after transplant.
Collapse
Affiliation(s)
- Sedef Selçuk Topbaş
- From Metin Sabanci Bone Diseases Training and Research Hospital, Istanbul, Turkey
| | | |
Collapse
|
2
|
Górska M, Kurnatowska I. Nutrition Disturbances and Metabolic Complications in Kidney Transplant Recipients: Etiology, Methods of Assessment and Prevention-A Review. Nutrients 2022; 14:nu14234996. [PMID: 36501026 PMCID: PMC9738485 DOI: 10.3390/nu14234996] [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] [Received: 10/31/2022] [Revised: 11/20/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022] Open
Abstract
Nutrition disturbances occur at all stages of chronic kidney disease and progress with the decrease of the kidney filtration rate. Kidney transplantation (KTx) as the best form of kidney replacement therapy poses various nutritional challenges. Prior to transplantation, recipients often present with mild to advanced nutrition disturbances. A functioning allograft not only relieves uremia, acidosis, and electrolyte disturbances, but also resumes other kidney functions such as erythropoietin production and vitamin D3 metabolism. KTx recipients represent a whole spectrum of undernutrition and obesity. Since following transplantation, patients are relieved of most dietary restrictions and appetite disturbances; they resume old nutrition habits that result in weight gain. The immunosuppressive regimen often predisposes them to dyslipidemia, glucose intolerance, and hypertension. Moreover, most recipients present with chronic kidney graft disease at long-term follow-ups, usually in stages G2-G3T. Therefore, the nutritional status of KTx patients requires careful monitoring. Appropriate dietary and lifestyle habits prevent nutrition disturbances and may improve kidney graft function. Despite many nutritional guidelines and recommendations targeted at chronic kidney disease, there are few targeted at KTx recipients. We aimed to provide a brief review of nutrition disturbances and known nutritional recommendations for kidney transplant recipients based on the current literature and dietary trends.
Collapse
|
3
|
Bhat M, Usmani SE, Azhie A, Woo M. Metabolic Consequences of Solid Organ Transplantation. Endocr Rev 2021; 42:171-197. [PMID: 33247713 DOI: 10.1210/endrev/bnaa030] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Indexed: 12/12/2022]
Abstract
Metabolic complications affect over 50% of solid organ transplant recipients. These include posttransplant diabetes, nonalcoholic fatty liver disease, dyslipidemia, and obesity. Preexisting metabolic disease is further exacerbated with immunosuppression and posttransplant weight gain. Patients transition from a state of cachexia induced by end-organ disease to a pro-anabolic state after transplant due to weight gain, sedentary lifestyle, and suboptimal dietary habits in the setting of immunosuppression. Specific immunosuppressants have different metabolic effects, although all the foundation/maintenance immunosuppressants (calcineurin inhibitors, mTOR inhibitors) increase the risk of metabolic disease. In this comprehensive review, we summarize the emerging knowledge of the molecular pathogenesis of these different metabolic complications, and the potential genetic contribution (recipient +/- donor) to these conditions. These metabolic complications impact both graft and patient survival, particularly increasing the risk of cardiovascular and cancer-associated mortality. The current evidence for prevention and therapeutic management of posttransplant metabolic conditions is provided while highlighting gaps for future avenues in translational research.
Collapse
Affiliation(s)
- Mamatha Bhat
- Multi Organ Transplant program and Division of Gastroenterology & Hepatology, University Health Network, Ontario M5G 2N2, Department of Medicine, University of Toronto, Ontario, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Shirine E Usmani
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada.,Division of Endocrinology and Metabolism, Department of Medicine, University Health Network, Ontario, and Sinai Health System, Ontario, University of Toronto, Toronto, Ontario, Canada
| | - Amirhossein Azhie
- Multi Organ Transplant program and Division of Gastroenterology & Hepatology, University Health Network, Ontario M5G 2N2, Department of Medicine, University of Toronto, Ontario, Canada.,Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Minna Woo
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada.,Division of Endocrinology and Metabolism, Department of Medicine, University Health Network, Ontario, and Sinai Health System, Ontario, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
4
|
Sabbatini M, Ferreri L, Pisani A, Capuano I, Morgillo M, Memoli A, Riccio E, Guida B. Nutritional management in renal transplant recipients: A transplant team opportunity to improve graft survival. Nutr Metab Cardiovasc Dis 2019; 29:319-324. [PMID: 30782507 DOI: 10.1016/j.numecd.2019.01.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 01/02/2019] [Accepted: 01/02/2019] [Indexed: 12/27/2022]
Abstract
AIMS The nutritional management of renal transplant recipients (RTR) represents a complex problem either because the recovery of renal function is not complete and for the appearance of "unavoidable" metabolic side effects of immunosuppressive drugs. Nevertheless, it remains a neglected problem, whereas an appropriate dietary intervention could favorably affect graft survival. DATA SYNTHESIS Renal transplantation is associated with steroids and calcineurin inhibitors administration, liberalization of diet after dialysis restrictions, and patients' better quality of life. These factors predispose, from the first months after surgery, to body weight gain, enhanced post transplant diabetes, hyperlipidemia, metabolic syndrome, with negative consequences on graft outcome. Unfortunately, specific guidelines about this topic and nutritional counseling are scarce; moreover, beyond the low adherence of patients to any dietary plan, there is a dangerous underestimation of the problem by physicians, sometimes with inadequate interventions. A prompt and specific nutritional management of RTR can help prevent or minimize these metabolic alterations, mostly when associated with careful and repeated counseling. CONCLUSIONS A correct nutritional management, possibly tailored to enhance patients' motivation and adherence, represents the best preventive maneuver to increase patients' life and probably improve graft survival, at no cost and with no side effects.
Collapse
Affiliation(s)
- M Sabbatini
- Department of Public Health, University Federico II of Naples, Via Pansini 5, 80131, Naples, Italy.
| | - L Ferreri
- Department of Public Health, University Federico II of Naples, Via Pansini 5, 80131, Naples, Italy
| | - A Pisani
- Department of Public Health, University Federico II of Naples, Via Pansini 5, 80131, Naples, Italy
| | - I Capuano
- Department of Public Health, University Federico II of Naples, Via Pansini 5, 80131, Naples, Italy
| | - M Morgillo
- Department of Clinical Medicine and Surgery, University Federico II of Naples, Via Pansini 5, 80131, Naples, Italy
| | - A Memoli
- Department of Public Health, University Federico II of Naples, Via Pansini 5, 80131, Naples, Italy
| | - E Riccio
- Department of Public Health, University Federico II of Naples, Via Pansini 5, 80131, Naples, Italy
| | - B Guida
- Department of Clinical Medicine and Surgery, University Federico II of Naples, Via Pansini 5, 80131, Naples, Italy
| |
Collapse
|
5
|
Broers NJH, Fung TY, Kooman JP, Christiaans MHL. Living-donor transplantation leads to a major improvement in physical functioning: an observational study on the impact on potential donors and their recipients. BMC Nephrol 2019; 20:109. [PMID: 30922268 PMCID: PMC6440145 DOI: 10.1186/s12882-019-1299-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 03/17/2019] [Indexed: 12/27/2022] Open
Abstract
Background Prospective studies combining physical functioning (PF), physical activity (PA), and body composition (BC) after living donor transplantation/donation are scarce. We aimed to study differences in these parameters between kidney transplant recipients and their living donors by examining changes in these parameters in the first post-operative year in both groups. Methods Twenty-two kidney transplant recipients and 22 healthy kidney donors were included in this prospective longitudinal study with a follow-up until twelve months. PF was assessed by handgrip strength (HGS), and by the physical domains of health-related quality of life (HRQOL) using the Short Form-36 questionnaire [PF (SF-36 PF) and physical component summary (PCS) score]. BC was measured by the Body Composition Monitor©, and PA was measured by the SenseWear™ pro3. Results At baseline, recipients had significantly lower HGS (after adjustment for sex and body weight), SF-36 PF, PCS, and PA, as compared with their donors. In recipients HGS significantly increased in the first year after transplantation, but PA did not change in the first six months after transplantation. Furthermore, no significant increase in lean tissue mass was observed. For healthy donors no significant changes in these parameters were observed, with exception of SF-36 PF, which declined in the first three months after donation, but equaled baseline values after twelve months. Conclusion Recipients showed impressive improvements in PF and the physical domains of HRQOL in the first year after transplantation, reaching levels of healthy kidney donors already three to six months after transplantation. On the contrary, living kidney donation did not show any deterioration of the investigated parameters, supporting little impact for well-screened donors, while there is high benefit for transplant recipients.
Collapse
Affiliation(s)
- Natascha J H Broers
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center+, PO Box 5800, 6202 AZ, Maastricht, The Netherlands. .,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
| | - Tsz Yeung Fung
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center+, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Jeroen P Kooman
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center+, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Maarten H L Christiaans
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center+, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
6
|
Hap K, Madziarska K, Hap W, Zmonarski S, Zielińska D, Kamińska D, Banasik M, Kościelska-Kasprzak K, Klinger M, Mazanowska O. Are Females More Prone Than Males to Become Obese After Kidney Transplantation? Ann Transplant 2019; 24:57-61. [PMID: 30737367 PMCID: PMC6367887 DOI: 10.12659/aot.912096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Being overweight for kidney transplant recipients can cause serious side effects. Weight gain affects two-thirds of kidney transplant recipients and has been attributed to a more liberal diet after transplantation, recovery of appetite due to lack of uremic toxicity, corticosteroid use, and inadequate lifestyle changes. The aim of this study was to assess gender-dependent profile of body mass index (BMI) changes after kidney transplantation (KTx). Material/Methods Sixty-two kidney transplant recipients (38 males and 24 females), aged 46.0±12.8 years at KTx, were observed according to weight gain after KTx. BMI was calculated before transplantation (pre-KTx) and at 6, 12, and 24 months post-KTx. Results During the 24-month observation period, we found an increase in the incidence of kidney transplant recipients being overweight or obese (pre-KTx 43.5% increase and 24-month post-Ktx 61.3% increase, P=0.036). We analyzed a number of factors that could potentially influence a 24-month BMI gain including age at KTx, gender, pre-KTx BMI, time on dialysis, pre-KTx glucose metabolism disorder, and post-KTx diabetes mellitus. For female recipients, there was a significant step-wise post-KTx increase in BMI during the 24-month observation period. The overall pre-KTx to 24-month net increase for female BMI was 2 times greater than that observed for male recipients (1.90±2.20 kg/m2 versus 0.89±1.85 kg/m2, P<0.001). Conclusions Weight gain after KTx was observed in both sexes, but the net BMI increase was more than 2 times greater in females than in males at 24-months post-KTx. This indicated the need for diet education and strict weight control in kidney transplant recipients, especially in female patients.
Collapse
Affiliation(s)
- Katarzyna Hap
- Department of Nephrology and Transplantation Medicine, Wrocław Medical University, Wrocław, Poland
| | - Katarzyna Madziarska
- Department of Nephrology and Transplantation Medicine, Wrocław Medical University, Wrocław, Poland
| | - Wojciech Hap
- Second Department of General and Oncological Surgery, Wrocław Medical University, Wrocław, Poland
| | - Sławomir Zmonarski
- Department of Nephrology and Transplantation Medicine, Wrocław Medical University, Wrocław, Poland
| | - Dorota Zielińska
- Department of Nephrology and Transplantation Medicine, Wrocław Medical University, Wrocław, Poland
| | - Dorota Kamińska
- Department of Nephrology and Transplantation Medicine, Wrocław Medical University, Wrocław, Poland
| | - Mirosław Banasik
- Department of Nephrology and Transplantation Medicine, Wrocław Medical University, Wrocław, Poland
| | | | - Marian Klinger
- Department of Nephrology and Transplantation Medicine, Wrocław Medical University, Wrocław, Poland
| | - Oktawia Mazanowska
- Department of Nephrology and Transplantation Medicine, Wrocław Medical University, Wrocław, Poland.,Faculty of Medicine and Dentistry, Wrocław Medical University, Wrocław, Poland
| |
Collapse
|
7
|
Henggeler CK, Plank LD, Ryan KJ, Gilchrist EL, Casas JM, Lloyd LE, Mash LE, McLellan SL, Robb JM, Collins MG. A Randomized Controlled Trial of an Intensive Nutrition Intervention Versus Standard Nutrition Care to Avoid Excess Weight Gain After Kidney Transplantation: The INTENT Trial. J Ren Nutr 2018; 28:340-351. [PMID: 29729825 DOI: 10.1053/j.jrn.2018.03.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 02/22/2018] [Accepted: 03/13/2018] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Excessive weight gain is common after kidney transplantation and increases cardiovascular risk. The aim of this randomized controlled trial was to determine whether an intensive nutrition and exercise intervention delivered alongside routine post-transplant care would reduce post-transplant weight gain. DESIGN Single-blind, randomized controlled trial. SUBJECTS AND SETTING Adult kidney transplant recipients at a regional transplant center were recruited during routine outpatient clinic visits in the first month after transplant. Patients with a body mass index >40 kg/m2 or <18.5 kg/m2, severe malnutrition, or ongoing medical complications were excluded. INTERVENTION Participants were randomized to intensive nutrition intervention (individualized nutrition and exercise counselling; 12 dietitian visits; 3 exercise physiologist visits over 12 months) or to standard nutrition care (guideline based; 4 dietitian visits). MAIN OUTCOME MEASURES The primary outcome was weight at 6 months after transplant adjusted for baseline weight, obesity, and gender, analyzed using analysis of covariance. The secondary outcomes included body composition, biochemistry, quality of life, and physical function. RESULTS Thirty-seven participants were randomized to the intensive intervention (n = 19) or to standard care (n = 18); one intensive group participant withdrew before baseline. Weight increased between baseline, 6 and 12 months (78.0 ± 13.7 [standard deviation], 79.6 ± 13.0 kg, 81.6 ± 12.9 kg; mean change 4.6% P < .001) but at 6 months did not differ significantly between the groups: 77.0 ± 12.4 kg (intensive); 82.2 ± 13.4 kg (standard); difference in adjusted means 0.4 kg (95% confidence interval: -2.2 to 3.0 kg); analysis of covariance P = .7. No between-group differences in secondary outcomes were observed. Across the whole cohort, total body protein and physical function (gait speed, sit to stand, grip strength, physical activity, and quality of life [all but 2 domains]) improved. However, adverse changes were seen for total body fat, HbA1c, and fasting glucose across the cohort. CONCLUSIONS Kidney transplant recipients in the first year after transplant did not benefit from an intensive nutrition intervention compared with standard nutrition care, although weight gain was relatively modest in both groups.
Collapse
Affiliation(s)
- Cordula K Henggeler
- Discipline of Nutrition, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Lindsay D Plank
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Kristin J Ryan
- Discipline of Nutrition, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Emily L Gilchrist
- Discipline of Nutrition, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jessie M Casas
- Nutrition Services, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Lyn E Lloyd
- Nutrition Services, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Laura E Mash
- Nutrition Services, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Sandra L McLellan
- Nutrition Services, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Jennifer M Robb
- Nutrition Services, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Michael G Collins
- Department of Renal Medicine, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand; Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
| |
Collapse
|
8
|
Forcellini Pedrollo E, Bellincanta Nicoletto B, Salomoni Carpes L, de Melo Cardoso de Freitas J, Buboltz JR, Carra Forte C, Bauer AC, Ceratti Manfro R, Corrêa Souza G, Bauermann Leitão C. Effect of an intensive nutrition intervention of a high protein and low glycemic-index diet on weight of kidney transplant recipients: study protocol for a randomized clinical trial. Trials 2017; 18:413. [PMID: 28874181 PMCID: PMC5585938 DOI: 10.1186/s13063-017-2158-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 08/21/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Excessive weight gain is commonly observed within the first year after kidney transplantation and is associated with negative outcomes, such as graft loss and cardiovascular events. The purpose of this study is to evaluate the effect of a high protein and low glycemic-index diet on preventing weight gain after kidney transplantation. METHODS We designed a prospective, single-center, open-label, randomized controlled study to compare the efficacy of a high protein (1.3-1.4 g/kg/day) and low-glycemic index diet versus a conventional diet (0.8-1.0 g/kg/day of protein) on preventing weight gain after kidney transplantation. A total of 120 eligible patients 2 months after transplantation will be recruited. Patients with an estimated glomerular filtration rate through the modification of diet of renal disease (MDRD) formula < 30 mL/min/1.73 m2 or urinary albumin excretion > 300 mg/24 h will be excluded. Patients' diets will be allocated through simple sequential randomization. Patients will be followed-up for 12 months with nine clinic appointments with a dietitian and the evaluations will include nutritional assessment (anthropometrics, body composition, and resting metabolic rate) and laboratory tests. The primary outcome is weight maintenance or body weight gain under 5% after 12 months. Secondary outcomes include body composition, resting metabolic rate, satiety sensation, kidney function, and other metabolic parameters. DISCUSSION Diets with higher protein content and lower glycemic index may lead to weight loss because of higher satiety sensation. However, there is a concern about the association of high protein intake and kidney damage. Nevertheless, there is little evidence on the impact of high protein intake on long-term kidney function outcome. Therefore, we designed a study to test if a high protein diet with low-glycemic index will be an effective and safe nutritional intervention to prevent weight gain in kidney transplant patients. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT02883777 . Registered on 3 August 2016.
Collapse
Affiliation(s)
- Elis Forcellini Pedrollo
- Post Graduate Program in Health Sciences, Endocrinology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 90035-003 Porto Alegre, RS Brazil
| | - Bruna Bellincanta Nicoletto
- Post Graduate Program in Health Sciences, Endocrinology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 90035-003 Porto Alegre, RS Brazil
- Nutrition Course, Knowledge Area of Life Sciences, Universidade de Caxias do Sul, Caxias do Sul, RS Brazil
| | - Larissa Salomoni Carpes
- Nutrition Graduate Course, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil
| | | | - Julia Roberta Buboltz
- Nutrition Graduate Course, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil
| | - Cristina Carra Forte
- Post Graduate Program in Health Sciences, Endocrinology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 90035-003 Porto Alegre, RS Brazil
| | - Andrea Carla Bauer
- Post Graduate Program in Health Sciences, Endocrinology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 90035-003 Porto Alegre, RS Brazil
- Department of Internal Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 90035-003 Porto Alegre, RS Brazil
| | - Roberto Ceratti Manfro
- Department of Internal Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 90035-003 Porto Alegre, RS Brazil
- Post Graduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 90035-003 Porto Alegre, RS Brazil
| | - Gabriela Corrêa Souza
- Department of Nutrition, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS Brazil
- Food and Nutrition Research Center, Hospital de Clínicas de Porto Alegre (HCPA-UFRGS), Porto Alegre, RS Brazil
| | - Cristiane Bauermann Leitão
- Post Graduate Program in Health Sciences, Endocrinology, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 90035-003 Porto Alegre, RS Brazil
- Department of Internal Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, 90035-003 Porto Alegre, RS Brazil
| |
Collapse
|
9
|
|
10
|
Ryan KJ, Casas JMS, Mash LE, McLellan SL, Lloyd LE, Stinear JW, Plank LD, Collins MG. The effect of intensive nutrition interventions on weight gain after kidney transplantation: protocol of a randomised controlled trial. BMC Nephrol 2014; 15:148. [PMID: 25204676 PMCID: PMC4176865 DOI: 10.1186/1471-2369-15-148] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 09/02/2014] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Weight gain and obesity are common after kidney transplantation, particularly during the first year. Obesity is a risk factor for the development of new-onset diabetes after transplantation, and is associated with reduced graft survival. There is a lack of evidence for effective interventions to prevent weight gain after kidney transplantation. METHODS/DESIGN The effect of INTEnsive Nutrition interventions on weight gain after kidney Transplantation (INTENT) trial is a single-blind (outcomes assessor), randomised controlled trial to assess the effect of intensive nutrition interventions, including exercise advice, on weight gain and metabolic parameters in the first year after transplantation. Participants will be randomised during the first post-transplant month to either standard care (four visits with a renal dietitian over twelve months) or intensive nutrition intervention (eight visits with a renal dietitian over the first six months, four visits over the second six months, and three visits over the first six months with an exercise physiologist). In the intensive intervention group, nutrition counselling will be provided using motivational interviewing techniques to encourage quality engagement. Collaborative goal setting will be used to develop personalised nutrition care plans. Individualised advice regarding physical activity will be provided by an exercise physiologist. The primary outcome of the study is weight at six months after transplant, adjusted for baseline (one month post-transplant) weight, obesity and gender. Secondary outcomes will include changes in weight and other anthropometric measures over 12 months, body composition (in vivo neutron activation analysis, total body potassium, dual-energy X-ray absorptiometry, and bioelectrical impedance), biochemistry (fasting glucose, lipids, haemoglobin A1c and insulin), dietary intake and nutritional status, quality of life, and physical function. DISCUSSION There are currently few randomised clinical trials of nutrition interventions after kidney transplantation. The INTENT trial will thus provide important data on the effect of intensive nutrition interventions on weight gain after transplant and the associated metabolic consequences. Additionally, by assessing changes in glucose metabolism, the study will also provide data on the feasibility of undertaking larger multi-centre trials of nutrition interventions to reduce the incidence or severity of diabetes after transplantation. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry Number: ACTRN12614000155695.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Michael G Collins
- Department of Renal Medicine, Auckland City Hospital, Auckland District Health Board, Private Bag 92024, Auckland 1142, New Zealand.
| |
Collapse
|