Nutritional Management of Kidney Transplant Recipients

Nutrition in Kidney Transplantation

“…Pre-transplant low body weight (BMI<20 kg/m 2 ), low muscle mass measured by serum creatinine and low serum albumin in hemodialysis patients are all associated with reduced graft and patient survival (31). Therefore, optimal nutritional status, including body composition, should be maintained in all end-stage renal disease patients on waiting lists to improve the results of kidney transplantation.…”

“…While serum albumin levels may progressively decrease one year after transplantation (32), the ideal intake of proteins for the stable renal transplant recipients has not been fully investigated. Many authors have suggested that during the immediate post-transplant phase, when high doses of prednisone are required, a protein intake of 0.8-1.5 g/kg per day, with an adequate energy intake of 30 to 35 kcal/kg per day could stabilize renal function while maintaining an adequate nutritional status (31, 33, 34). In patients with stable renal function or with declining function, protein intake should be reduced to 0.75 g/kg per day, with appropriate energy intake to attain and maintain healthy weight and nutritional status (31, 35).…”

“…A rapid decline in bone mineral density is frequent after transplantation and may continue during the first two years after transplantation (31). In renal transplant recipients, calcium, phosphorus, and vitamin D metabolism are influenced by several factors, such as the level of parathormone, the presence of fractures, bone loss, and the type of immunosuppression.…”

“…Hypophosphatemia is a common complication after kidney transplantation and may affect up to 90% of transplant recipients (31). Hypophosphatemia may have a negative effect on the muscular system, causing muscular weakness and, in more severe cases, even rhabdomyolysis (31). Hypophosphatemia may persist in most renal transplant recipients and a daily intake of 1200 to 1500 mg/d should be recommended (23).…”

“…In a recent study, Orazio et al (81) found that higher levels of exercise were associated with fewer diagnoses of insulin resistance and obesity, while kidney transplant recipients with irregular or limited physical activity, showed a significant increase in glucose blood levels and obesity. Moreover, patients with a higher BMI had more benefit from regular, structured consultations (82), and patients should be advised to consume approximately 50% carbohydrate-containing foods, which are rich in dietary fiber and have a low glycemic index, such as grain products and whole grain cereals (31, 35, 40–42).…”