Weight evolution during the first year of renal transplantation and the occurrence of Diabetes Mellitus after 5 years of follow-up

Authors

  • Rafaela Siviero Caron Lienert PUCRS
  • Carlos Eduardo Poli de Figueiredo PUCRS
  • Ana Elizabeth Prado Lima Figueiredo PUCRS

DOI:

https://doi.org/10.15448/1983-652X.2014.3.19754

Keywords:

renal transplantation, weight gain, nutritional status, nutritional and metabolic diseases

Abstract

Introduction: The late post-transplant period is characterizes by a series of nutritional changes, which can reduce organ and patient survival.

Objective: To evaluate the evolution of patient’s weight during the first year after renal transplantation (RT) and the occurrence of diabetes mellitus (DM) after 5 years of follow-up.

Materials and Methods: A retrospective cohort study was performed. Weight and other clinical data were collected in the records of the Department of Nephrology, São Lucas University Hospital of PUCRS in Porto Alegre.

Results: 35 patients were studied. At the end of the first year (data classified as T12), we observed an average weight gain of 8.2%, while 29 (82.9%) gained weight. The increase becomes significant from sixth month (T6) to ninth month (T9) in women and in men. The weight gain promotes impact on BMI, with significant difference between the beginning (T0) (23.2 ± 4.3kg/m2) and the end of the first year after RT (T12) (24.9 ± 4.4 kg/m2) (p<0.001). At the end of the fifth year, there were 6 deaths (17.1%) and 2 (5.7%) graft losses. Of the 27 patients, there was a 18.5% incidence of DM, which showed higher weight gain, although not statistically different, and an increase during the first year of RT (13.6% of usual weight) higher in comparison with the group that did not develop this condition (4.7% of the usual weight).

Conclusions: There was an increase in weight after one year of RT, and the patients who developed DM after 5 years of follow-up showed a different weight gain profile, although data were not significant.

Author Biography

Rafaela Siviero Caron Lienert, PUCRS

Nutricionista graduada pela UFRGS; Especialista em Nefrologia pelo Programa de Residência Multiprofissional em Saúde (PREMUS/PUCRS); Mestre em Nefrologia pela PUCRS; Doutoranda em nefrologia pela PUCRS; Nutricionista Assistencial da Unidade de Diálise do Hospital Moinhos de Vento.

References

Hariharan S, McBride A, Bennett LA, Cohen EP. Risk factors for renal allograft survival from older cadaver donors. Transplantation 1997; 64(12):1748-54.

Jezior D, Krajewska M, Madziarska K, Kurc-Darak B, Janczak D, Patrzalek D, Borysławski K, Klinger M.Posttransplant Owerweight and Obesity: myth or reality? Transplant Proc 2007; 39(9):2772-5.

Elster EA, Leeser DB, Morrissette C, Papek JM, Quiko A, Hale DA, Chamberlain C, Salaita C, Kirk AD, Mannon RB. Obesity following kidney transplantation and steriod avoidance immunosupression. Clin Transplant 2008; 22(3):354-9.

Fonseca AG, Mignone SC, Tuma da Ponte JR, Cruz AS, Souza FJ, Toscano PM, Ferreira de Almeida M, Lima SM. Análise dos resultados iniciais do programa de transplante renal intervivos no Estado do Pará. ABTO 2006; 10(1):525-9.

Hricik DE. Metabolic syndrome in kidney transplantation. Clin J Am Soc Nephrol 2011; 6(7):1781-5.

Hariharan S, Johnson CP, Bresnahan BA, Taranto SE, McIntosh MJ, Stablein D. Improved graft survival after renal transplantation in the United States, 1988 to 1996. N Engl J Med 2000; 342(9):605-12.

Lugon JR. Doença renal crônica no Brasil: um problema de saúde pública. J Bras Nefrol 2009; 31(1):2-5.

Wolf RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, Held PJ, Port FK. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med 1999; 341(23):1725-30.

Sesso RC, Lopes AA, Thome FS, Lugon JR, Santos DR. Dialysis Census Results - 2010 from the Brazilian Society of Nephrology J Bras Nefrol 2011; 33(4):442-7.

Silva DS, Ianhez LE. Characterization of the sample of patients under care in the Renal Transplant Unit of the Division of Urologic Clinic of HCFMUSP along two months. J Bras Transpl 2006; 9:525-9.

Chang SH, McDonald SP. Post-Kidney transplant weight change as marker of poor survival outcomes. Transplant 2008; 85(10):1443-3.

Souza GC, Costa C, Scalco R, Gonçalves LV, Manfro RC. Serum leptin, insulin resistance, and body fat after renal transplantation. J Ren Nutr 2008;8(6):479-88.

Stacey Phillips S, Heuberger R. Metabolic disorders following kidney transplantation. J Ren Nutr 2012; 22(5):451-60.

Kramer H, Luke A. Obesity and kidney disease: a big dilemma. Curr Opin Nephrol Hypertens 2007; 16(3):237-41.

Gore JL, Pham PT, Danovitch GM, Wilkinson AH, Rosenthal JT, Lipshutz GS, Singer JS. Obesity and outcome following renal transplantation. Am J Transplant 2006; 6(2):357-63.

Food and Agriculture Organization/World Health Organization. Physical Status: The use and interpretation of antropometry. Geneva, WHO, 1995 (WHO, offset publication, 854).

Guida B, Trio R, Laccetti R, Laccetti R, Nastasi A, Salvi E, Perrino NR, Caputo C, Rotaia E, Federico S, Sabbatini M. Role of dietary intervention on metabolism abnormalities and nutricional status after renal transplantation. Nephrol Dial Transplant 2007;22(11):3304-10.

Associação Brasileira de Transplante de Órgãos. Registro Brasileiro de Transplantes 2011; XVII(4):1-19. [acessado 2012 jul. 4]. Disponível em: http://www.abto.org.br/abtov02/portugues/populacao/rbt.

Marceón R, Fernández J, Pascual J, Teruel JL, Villafruela JJ, Rodriguez N, Martins J, Burgos FJ, Ortuño J. High body massa index and posttransplant weight gain are not risk factors for kidney graft and patient outcome. Transpl Proc 2007; 39(7):2205-7.

Kent PS. Issues of obesity in kidney transplantation. J Ren Nutr 2007; 17(2):107-13.

Ward HJ. Nutritional and metabolic issues in solid organ transplantation: targets for future research. J Ren Nutr 2009; 19(1):111-22.

Hricik DE. Metabolic syndrome in kidney transplantation: management of risk factors. Clin J Am Soc Nephrol 2011; 6(7):1781-5.

Teixeira APSF, Fernandes NMS, Mata GF, Chaoubah A, Paula RB, Bastos MG. Prevalence of metabolic syndrome in renal transplantation. J Bras Nefrol 2012; 34(1):16-21.

Hasse J. Pretransplant obesity: a weighty issue affecting transplant candidacy and outcomes. Nutr Clin Pract 2007; 22(5):494-504.

Coroas A, Oliveira JG, Sampaio S, Borges C, Tavares I, Pestana M, Almeida MD. Nutritional status and body composition evolution in early post-renal transplantation: is there a female advantage? Transplant Proc 2005; 37(6):2765-70.

Coroas ASPS, Oliveira JGG, Sampaio SMM, Tavares IC, Pestana M, Almeida MD. Postrenal Transplantation Body Composition: Different Evolution Depending on Gender. J Ren Nutr 2007; 17(2):151-6.

Armstrong KA, Campbell SB, Hawley CM, Johnson DW, Isbel NM. Impact of obesity on renal transplant outcomes. Nephrology (Carlton) 2005; 10(4):405-13.

Kalantar-Zadeh K, Abbott KC, Salahudeen AK,Kilpatrick RD, Horwich TB. Survival advantages of obesity in dialysis patients. Am J Clin Nutr 2005; 81(3):543-54.

Bellinghieri G, Bernadri A, Piva M, Pati T, Stoppa F, Scaramuzzo P, Garizzo O, Santoro D, Savica V, Bucciante G. Metabolic syndrome after kidney transplantation. J Ren Nutr. 2009; 19(1):105-10.

Jezior D, Krajewsk K, Madziarska B, Regulska-Ilow B, Ilow R, Jańczak D, Patrzałek D, Klinger M. Weigth Rediction in Renal Transplant Recipients Program: the first successes. Transpl Proc 2007; 39(9):2769-71.

Teplan V, Valkovsky I, Teplan VJ, Stollova M, Vyhnanek F, Andel M. Nutritional consequences of renal transplantation. J Ren Nutr 2009; 19(1):95-100.

Mazzali F, Lalli A, Alves-Filho G, Mazzali M. Posttransplant Diabetes Mellitus: incidence and risk factors. Transplant Proc 2008; 40(3):764-6.

Rodrigo E, de Cos MA, Fernández-Fresnedo G, Sanchez B, Ruiz JC, Piñera C, Palomar R, Cotorruelo JG, Gómez-Alamillo C, de Castro SS, de Francisco AL, Arias M. Higher Initial Tacrolimos Blood Levels and Concentration-Dose Rations in Kidney Transplant Recipient Who Develop Diabetes Mellitus. Transplant Proc 2005; 37(9):3819-20.

Published

2014-12-31

Issue

Section

Original Articles