Nutrition Trends in Kidney Transplant Recipients: the Importance of Dietary Monitoring and Need for Evidence-Based Recommendations

Abstract

Many physiological properties of the renal system influence nutrient metabolism, elimination, and homeostasis. Kidney failure poses significant challenges to maintaining adequate nutrition, most of which transplantation ameliorates. Comprehensive recommendations for managing nutritional derangements for patients with chronic kidney disease and end stage renal disease exist; however, there are only sparse guidelines for post-transplant malnutrition and adverse outcomes. Not only are guidelines limited, but little is known about dietary trends of post-kidney transplant recipients. This review describes guidelines for prevalent metabolic and nutritional complications post-kidney transplantation and also evaluates changes in caloric intake and diet composition after transplantation. This topic is important because nutrition influences allograft function and a number of cardiovascular risk factors including blood pressure, dyslipidemia, weight, and diabetes. In addition, many dietary recommendations and modifiable lifestyle changes should be tailored for specific complications of transplant patients, namely immunosuppression side effects, dietary restrictions, and electrolyte imbalances.

Side Effects of Cyclosporine Compared to Tacrolimus Among Yemeni Kidney Transplant Patients Who Share the Same Adjuvant Agents: Mycophenolate Mofetil and Prednisone

“…Lipid profiles including total cholesterol, HDL, LDL, TG were significantly altered with cyclosporine and elevated in comparison to tacrolimus group in the current study. This results were similar to those obtained by another studies which assessed hyperlipidemia is one of the metabolic adverse effects of cyclosporine and tacrolimus but its greater in cyclosporine A than in tacrolimus the mechanism related to cyclosporine alteration of lipids is through its direct effect on cell membrane cholesterol concentration and regulatory pools, resulting in both increased synthesis of cholesterol and decreased clearance of LDL, HDL levels are typically normal or elevated in obesity; however cardio protective HDL fraction may remain low 28,30 . The total blood cell counts were similar in the two study groups, and this is in agreement with another studies that assessed cyclosporine A and corticosteroids which have no suppressor effects on bone marrow cells, also mycophenolate mofetil usually do not cause bone marrow suppression 31 , even if another study found that prednisone inhibited the expression of polymorphoneutriphils to the tissue .This lead in turn to their accumulation in the peripheral blood 32 .…”

Lifestyle, Inflammation, and Vascular Calcification in Kidney Transplant Recipients: Perspectives on Long-Term Outcomes

“…Next, under the general understanding that cardiovascular disease is the leading cause of premature death post-kidney transplant ( Figure 3) and thereby importantly challenging the improvement of longevity of KTR, great efforts have focused on the improvement of long-term cardiovascular outcomes [19][20][21]. In the clinical setting of KTR after the first-year post-transplant, beyond hazards of immunological nature, there is a pressing need to systematically study and characterize the clinical impact of potentially modifiable risk factors, such as lifestyle, diet, and exposure to toxic contaminants, which are underexplored areas in the kidney transplantation field [22][23][24][25][26]. This evidence is needed to guide decision making by clinicians and policy-makers in post-transplantation care.…”

“…Furthermore, because kidney transplantation aims to restore kidney function but it incompletely mitigates collateral mechanisms of disease, such as chronic low-grade inflammation with persistent redox imbalance and deregulated mineral and bone metabolism, further research investigating specific clinical and laboratory readouts with a proposed involvement in such pathological pathways may point towards non-traditional risk factors and reveal novel targets for clinical intervention [27][28][29][30][31][32]. In the clinical setting of KTR after the first-year post-transplant, beyond hazards of immunological nature, there is a pressing need to systematically study and characterize the clinical impact of potentially modifiable risk factors, such as lifestyle, diet, and exposure to toxic contaminants, which are underexplored areas in the kidney transplantation field [22][23][24][25][26]. This evidence is needed to guide decision making by clinicians and policy-makers in post-transplantation care.…”

“…In the clinical setting of KTR after the first-year post-transplant, beyond hazards of immunological nature, there is a pressing need to systematically study and characterize the clinical impact of potentially modifiable risk factors, such as lifestyle, diet, and exposure to toxic contaminants, which are underexplored areas in the kidney transplantation field [ 22 , 23 , 24 , 25 , 26 ]. This evidence is needed to guide decision making by clinicians and policy-makers in post-transplantation care.…”

Urinary Excretion of N1-Methylnicotinamide and N1-Methyl-2-Pyridone-5-Carboxamide and Mortality in Kidney Transplant Recipients

“…Despite advances in short-term outcome, kidney transplant recipients (KTR) remain at highly increased risk of premature mortality compared to the general population [ 3 , 4 ]. Nutrition is increasingly acknowledged as a modifiable factor to improve prospects in KTR [ 5 ]. Many factors, such as dietary restrictions, stress, medication use, and comorbidities, pose a challenge to maintain adequate nutrition after renal transplantation [ 5 , 6 , 7 , 8 , 9 , 10 ], while adequate nutrition has been implicated to prevent clinical conditions that adversely affect long-term outcome and premature mortality in KTR [ 11 , 12 , 13 , 14 , 15 , 16 , 17 ].…”