Do Exercise, Physical Activity, Dietetic, or Combined Interventions Improve Body Weight in New Kidney Transplant Recipients? A Narrative Systematic Review and Meta-Analysis

Abstract

Weight gain within the first year of kidney transplantation is associated with adverse outcomes. This narrative systematic review and meta-analysis examines the effect of exercise, physical activity, dietary, and/or combined interventions on body weight and body mass index (BMI) within the first year of kidney transplantation. Seven databases were searched from January 1985 to April 2021 (Prospero ID: CRD42019140865), using a ‘Population, Intervention, Controls, Outcome’ (PICO) framework. The risk-of-bias was assessed by two reviewers. A random-effects meta-analysis was conducted on randomized controlled trials (RCTs) that included post-intervention body weight or BMI values. Of the 1197 articles screened, sixteen met the search criteria. Ten were RCTs, and six were quasi-experimental studies, including a total of 1821 new kidney transplant recipients. The sample sizes ranged from 8 to 452. Interventions (duration and type) were variable. Random-effects meta-analysis revealed no significant difference in post-intervention body weight (−2.5 kg, 95% CI −5.22 to 0.22) or BMI (−0.4 kg/m2, 95% CI −1.33 to 0.54). Despite methodological variance, statistical heterogeneity was not significant. Sensitivity analysis suggests combined interventions warrant further investigation. Five RCTs were classified as ‘high-risk’, one as ‘some-concerns’, and four as ‘low-risk’ for bias. We did not find evidence that dietary, exercise, or combined interventions led to significant changes in body weight or BMI post kidney transplantation. The number and quality of intervention studies are low. Higher quality RCTs are needed to evaluate the immediate and longer-term effects of combined interventions on body weight in new kidney transplant recipients.

The Feasibility and User-Experience of a Digital Health Intervention Designed to Prevent Weight Gain in New Kidney Transplant Recipients—The ExeRTiOn2 Trial

“…The need for support to engage with online interventions is echoed in the few studies that explore PA and dietary combined interventions in new KTRs ( 15 ). Exit survey data from Serper et al ( 72 ) reported participants would have valued technical support and contact with the research team.…”

“…They have also been associated with appetite stimulation and changes in nutrient partitioning that favor fat deposition ( 14 ). Therefore, interventions to address weight gain and modifiable risk factors such as physical activity and healthy eating behaviors are warranted ( 15 ).…”

“…Despite national clinical practice ( 18 ) and workforce practice guidelines ( 19 ) that recommend access to both kidney physiotherapists and dietitians, these healthcare professionals (HCPs) are not routinely represented in all transplant centers ( 20 ). Whilst COVID-19 has seen an increase in virtual kidney services ( 21 ), and the creation of online PA and well-being interventions for people living with chronic kidney disease ( 22 ), there remains no recognized intervention to prevent weight gain in new KTRs ( 15 ).…”

“…A recent systematic review and meta-analyses ( 15 ) revealed that there was no evidence that dietary, exercise, or combined interventions led to significant changes in body weight or body mass index (BMI) in a pooled sample of participants within the first year of receiving a kidney transplant. Limitations of the review include small number of randomized-controlled trials (RCTs) with significant methodological variation, and variable quality study design ( 17 ).…”

The Importance of Lifestyle Interventions in the Prevention and Treatment of Chronic Kidney Disease

“…Whilst weight gain is a significant issue for new kidney transplant recipients, there is no recommended intervention designed to prevent adverse weight gain from occurring [27]. The systematic review and meta-analysis by Castle et al [28] Behavioural change techniques are recommended to facilitate physical activity and dietary interventions [29]. In this Special Issue, Leunis et al [30] explore physical activity behaviour in solid organ transplant recipients.…”