Nutritional and dietary interventions to prolong renal allograft survival after kidney transplantation

Tantisattamo, Ekamol; Kalantar-Zadeh, Kamyar; Molnar, Miklos Z.

doi:10.1097/mnh.0000000000000757

Cited by 5 publications

(3 citation statements)

References 113 publications

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“…At both the T1 and T2 stages, the protein intake of our participants was approximately 1.1 g/kg, and more than 80% of the RTRs exceeded the recommendations by the DAA, potentially increasing the workload on the transplanted kidney. Such excessive protein intake may trigger renal arteriolar vasodilation, leading to glomerular hyperfiltration and subsequent glomerular damage [ 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

Changes in Dietary Nutrient Intake and Estimated Glomerular Filtration Rate over a 5-Year Period in Renal Transplant Recipients

Lin,

Chen,

Duong

et al. 2023

Nutrients

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The scarcity of dietary guidance for renal transplant recipients (RTRs) raises concerns regarding obesity and associated comorbidities, including impaired renal function. This two-stage cross-sectional study examined longitudinal changes in dietary nutrient intake in the same individuals over a 5-year interval. This study involved two stages: T1 (September 2016 to June 2018) and T2 (July 2022 to August 2023). The average duration between the two data collection stages was 6.17 ± 0.42 (range 5.20–6.87) years. The study included 227 RTRs with an average age and time since transplant of 49.97 ± 12.39 and 9.22 ± 7.91 years, respectively. Of the 35 patients who participated in both phases, fewer than half met the recommended intakes for energy, dietary fiber, and most vitamins and minerals, as set in the Dietary Reference Intakes (DRIs) or by the Dietitian Association Australia (DAA). Over half exceeded the DRI recommended intake for total protein, and more than 80% of the protein consumed per kilogram of body weight exceeded the DAA’s recommendations. In the T2 stage, the RTRs had a significantly higher blood urea nitrogen level, lower albumin level, and estimated glomerular filtration rate. These findings indicate that deteriorating dietary intake in RTRs can adversely affect their nutritional status and transplanted kidney function over a 5-year period.

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Section: Discussionmentioning

confidence: 99%

Changes in Dietary Nutrient Intake and Estimated Glomerular Filtration Rate over a 5-Year Period in Renal Transplant Recipients

Lin,

Chen,

Duong

et al. 2023

Nutrients

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“…Evidence regarding the association of dietary patterns with kidney allograft function was summarized in our previous review [10 ▪ ].…”

Section: Dietary Protein Intake and Kidney Allograft Functionmentioning

confidence: 99%

Dietary protein intake and plant-dominant diets to mitigate risk of allograft dysfunction progression in kidney transplant recipients

Tantisattamo,

Kalantar-Zadeh

2023

Current Opinion in Nephrology &Amp; Hypertension

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Purpose of review There are limited studies on the benefits of low dietary protein intake (DPI) and plant-dominant diets to delay kidney allograft dysfunction. We evaluate evidence regarding the association or effects of the amount and type of DPI on allograft function. Recent findings There is conflicting evidence regarding the benefits of low DPI and plant-dominant diet including PLADO and PLAFOND on kidney allograft function. Taking the strength of evidence including study design, sample size, and time to follow-up, the proposed amount of DPI to slow the progression of allograft dysfunction, avoid negative nitrogen balance, and skeletal muscle mass loss is 1.0–1.3 g/kg/day during an immediate posttransplant period or when high protein catabolic rate exists. The DPI may be 0.8–1.0 g/kg/day in patients with stable allograft function. Patients with chronic allograft rejection or estimated glomerular filtration rate <25 ml/min may benefit from the DPI of 0.55–0.60 g/kg/day, while those with failed allograft requiring transition to dialysis including incremental (twice-weekly) hemodialysis should consider increasing DPI to 1.0–1.2 g/kg/day. Summary While there is a lack of strong evidence, individualized approaches based on the patient's comorbidities, net state of immunosuppression, and periods posttransplant may guide the appropriate amount and type of DPI to slow allograft dysfunction.

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“…Adherence to the Mediterranean diet in renal transplant recipients has been linked to better nutritional status and lower risk for metabolic syndrome in long-term follow-up, along with better preservation of allograft function [ 67–71 ]. Similarly, the DASH diet is also linked to better long-term renal allograft function preservation [ 72 , 73 ]. Thus adherence to such a diet is associated with better allograft function, but future large-scale randomized studies are required in order to make a strong recommendation.…”

Section: Perspectivesmentioning

confidence: 99%

Donor obesity and weight gain after transplantation: two still overlooked threats to long-term graft survival

Kanbay

Çöpür

Ucku

et al. 2022

Clinical Kidney Journal

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The effect of donor obesity on kidney transplantation success has long been an overlooked clinical research area. Even though there is no strict guideline in most countries prohibiting donation from obese individuals, most candidates with BMI over 35-40 kg/m2 are overturned due to concerns regarding the renal functional deterioration in the donor over the long run. The effects of excessive fat mass on renal function and allograft survival have been analyzed by several longitudinal and follow-up studies. These studies have documented the deleterious effect of long term graft outcomes by excessive body mass in living kidney donors and de novo obesity or pre-existing obesity worsening post transplantation on kidney outcomes. However, there is a paucity of clinical trials aimed at countering overweight and obesity in living or deceased kidney donors and in transplant patients. In this review, we will briefly review mechanism whereby fat excess may induce adverse kidney outcomes to then describe the effect on graft function and survival by living obese donors along with the effect post transplantation obesity on the same outcomes.

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Nutritional and dietary interventions to prolong renal allograft survival after kidney transplantation

Cited by 5 publications

References 113 publications

Changes in Dietary Nutrient Intake and Estimated Glomerular Filtration Rate over a 5-Year Period in Renal Transplant Recipients

Changes in Dietary Nutrient Intake and Estimated Glomerular Filtration Rate over a 5-Year Period in Renal Transplant Recipients

Dietary protein intake and plant-dominant diets to mitigate risk of allograft dysfunction progression in kidney transplant recipients

Donor obesity and weight gain after transplantation: two still overlooked threats to long-term graft survival

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