Nutrition Care for Renal Transplant Recipients: An Evaluation of Service Delivery and Outcomes

Orazio, Linda; Chapman, Jessica; Isbel, Nicole M.; Campbell, Katrina L.

doi:10.1111/jorc.12055

Cited by 14 publications

(10 citation statements)

References 35 publications

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“…The correlation between weight at baseline and 6 months was estimated as 0.9, based on data showing a mean difference in weight of 3.2 kg (SD 5.9 kg) between 1 and 6 months of 1299 kidney transplant recipients who received their kidney transplant in Auckland between 1991 and 2012 (unpublished observations, data on file), where the correlation was 0.9514. Similar findings were found in an analysis of weight change post-transplant in a comparable population of 156 transplant recipients in Brisbane, Australia (mean weight change 3.3 kg, SD 6.0 kg) (Campbell KL, personal communication) [18]. …”

Section: Methodssupporting

confidence: 76%

“…The extent of weight gain after transplant has been shown be significantly affected by baseline BMI [18]; gender will be included as a covariate due to its use as a stratification variable in the randomisation.…”

Section: Methodsmentioning

confidence: 99%

“…In the first year following kidney transplantation, there is a significant incidence of excess weight gain and obesity in transplant recipients, with average post-transplant weight gains of 10-35% reported [14–18]. These changes are associated with increased total body fat, reduced lean muscle mass and reduced bone mineral density [17, 19–22].…”

Section: Introductionmentioning

confidence: 99%

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The effect of intensive nutrition interventions on weight gain after kidney transplantation: protocol of a randomised controlled trial

et al. 2014

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BackgroundWeight 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/DesignThe 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.DiscussionThere 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 registrationAustralian New Zealand Clinical Trials Registry Number: ACTRN12614000155695

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Section: Methodssupporting

confidence: 76%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The effect of intensive nutrition interventions on weight gain after kidney transplantation: protocol of a randomised controlled trial

et al. 2014

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“…16 A retrospective study showed that 32% of patients who had normal body mass index and 23% of overweight patients were classified as obese 12 months after renal transplant. 17 Potential factors causing weight gain after renal transplant include use of immunosuppressive agents to protect the implanted organ, lack of physical activity, and other life style changes such as dietary intake. 16 Moreover, age , sex, 2,14,16,18 race, 2,16,18 absence of acute rejection, 2 and genetic 14,16 and psychological effects related to stress 16 can play roles in weight gain.…”

Section: Resultsmentioning

confidence: 99%

Untitled

2016

Exp Clin Transplant

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Objectives: Weight gain and obesity are frequent problems for renal transplant patients. The purpose of this review is to show why weight gain is experienced by patients after kidney transplant and the significance of prevention. Materials and Methods: To investigate this topic, PubMed and Ulakbim databases were searched with the following key words: renal transplant and transplantation, weight gain, and obesity. Results: Weight gain frequently appears in the first year after transplant, and it is reported to be a common problem for patients within the first 6 months. Weight gain varies between 6 and 10 kg, and the change in mean body mass index varies between 2 and 3.8 kg/m 2 after transplant. Potential factors causing weight gain after kidney transplant are the use of immunosuppressive medications to protect the newly implanted organ and the changes in life style, such as dietary intake and insufficient physical activity. In addition, weight gain is affected by factors such as age, sex, race, lack of acute rejection, genetics, and psychological factors related to stress. Conclusions: A better understanding of food intake, physical activities, and environmental factors causing weight gain after kidney transplant and the development of dietary intake and physical activity protocols specific to individuals would be helpful for health care professionals.

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“…Weight gain after kidney transplantation is very often observed and it has been reported to be between 10% and 35%, mainly during the first year after transplant [ 1 – 4 ]. Post-transplant overweight and obesity may lead to negative post-transplant outcomes, such as graft loss and cardiovascular events [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

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

Pedrollo

Nicoletto

Carpes

et al. 2017

Trials

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BackgroundExcessive 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.MethodsWe 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.DiscussionDiets 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 RegistrationClinicalTrials.gov identifier, NCT02883777. Registered on 3 August 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-2158-2) contains supplementary material, which is available to authorized users.

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Nutrition Care for Renal Transplant Recipients: An Evaluation of Service Delivery and Outcomes

Cited by 14 publications

References 35 publications

The effect of intensive nutrition interventions on weight gain after kidney transplantation: protocol of a randomised controlled trial

The effect of intensive nutrition interventions on weight gain after kidney transplantation: protocol of a randomised controlled trial

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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

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