A Randomized Controlled Trial of an Intensive Nutrition Intervention Versus Standard Nutrition Care to Avoid Excess Weight Gain After Kidney Transplantation: The INTENT Trial

Henggeler, Cordula; Plank, Lindsay D.; Ryan, Kristin J.; Gilchrist, Emily; Casas, Jessie M Segedin; Lloyd, Lyn; Mash, Laura E.; McLellan, Sandra L.; Robb, Jennifer M.; Collins, Michael G.

doi:10.1053/j.jrn.2018.03.001

Cited by 38 publications

(65 citation statements)

References 56 publications

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“…While it can be hypothesized that weight gain and consequently BMI increases with more extended time since transplantation as it does with growing age, we found no statistically significant difference regarding time since transplantation between BMI groups. A possible explanation might be that weight gain occurs predominantly in the first year after transplantation as suggested by Henggeler et al (27) and Aksoy (14). Henggeler et al (27) reported that the number of obese patients doubled by one year after transplantation, from 5.6 to 11.4%.…”

Section: Discussionmentioning

confidence: 97%

“…A possible explanation might be that weight gain occurs predominantly in the first year after transplantation as suggested by Henggeler et al (27) and Aksoy (14). Henggeler et al (27) reported that the number of obese patients doubled by one year after transplantation, from 5.6 to 11.4%. In our sample we observed a 34% increase of the rate of obese patients on average 48.5 months after transplantation.…”

Section: Discussionmentioning

confidence: 97%

“…Patients might benefit from strategies to prevent weight gain after KTx, particularly when they are already obese pre-transplant. However, information on obesity treatment and prevention in this special group of patients is still scarce (27,(39)(40)(41) and further research is required in this field.…”

Section: Discussionmentioning

confidence: 99%

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Obesity After Kidney Transplantation—Results of a KTx360°Substudy

et al. 2020

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Objective: There is solid evidence that kidney transplant (KTx) patients are susceptible to weight gain after transplantation. Post-transplantation obesity [body mass index (BMI) ≥ 30 kg/m 2 ] seems to be associated with higher risks of hypertension, dyslipidemia, diabetes mellitus, and cardiovascular events, while there are contradicting findings regarding the association between obesity and mortality, graft failure after transplantation as well as other variables. We aimed to evaluate the course of weight after KTx and to assess the prevalence of post-transplant obesity in a large sample of German KTx patients. Further, we focused on potential associations between weight gain, obesity, and BMI after transplantation with sociodemographic, medical, psychological [levels of anxiety and depression measured with the Hospital Anxiety and Depression Scale (HADS)], and donation-specific variables. Methods: In a structured post-transplant care program 433 KTx patients were evaluated at Hannover Medical School. Information on the pre-transplant body weight/dry weight of dialysis patients was taken from the electronic patient charts. At post-transplant assessment body weight was measured in the transplant center. For statistical analyses, descriptive statistics, analyses of variance, tests for correlations, and regression analyses were used. Results: Mean age was 51.3 years, 59% were male and 26.3% had ≥12 years of school attendance. Regarding somatic conditions 6.0% were suffering from type 2 diabetes mellitus, 6.9% were affected by new-onset diabetes after transplantation (NODAT), and the mean estimated glomerular filtration rate (eGFR) was 47.7 ml/min/1.73m 2. The prevalence rates of obesity before and after kidney transplantation were 14.8 and 19.9%, respectively. This represents an increase of 34%. Obesity after transplantation was associated with higher rates of type 2 diabetes mellitus and of NODAT. Additionally, there was an association between increasing pre-transplant as well as post-transplant BMI and decreasing eGFR. Higher age and female sex were associated with higher rates of post-transplant obesity.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 97%

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Obesity After Kidney Transplantation—Results of a KTx360°Substudy

et al. 2020

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“…Modest weight gain was noted from baseline to 3 months among both groups. Similarly, investigators of a randomized controlled study, involving intensive nutrition and exercise advice to prevent excessive weight gain among KTR, did not demonstrate any advantage over standard care in the first year after transplant although weight gain was relatively modest in both groups [30]. A non-randomized study found that significant weight gain can be attenuated with early intensive dietary advice and follow-up [31].…”

Section: Discussionmentioning

confidence: 99%

Feasibility and acceptability of a televideo physical activity and nutrition program for recent kidney transplant recipients

Gibson

Gupta

Greene

et al. 2020

Pilot Feasibility Stud

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Background Post-transplant weight gain affects 50–90% of kidney transplant recipients adversely affecting survival, quality of life, and risk for diabetes and cardiovascular disease. Diet modification and physical activity may help prevent post-transplant weight gain. Methods for effective implementation of these lifestyle modifications are needed. The objective of this study is to assess the feasibility and acceptability of a remotely delivered nutrition and physical activity intervention among kidney transplant recipients. Secondary aims were to estimate the effectiveness of the intervention in producing changes in physical activity, qualify of life, fruit and vegetable intake, and consumption of whole grains and water from baseline to 6 months. Methods A randomized controlled study for stable kidney transplant recipients between 6 and 12 months post-transplantation was conducted. Participants were randomly assigned 1:1 to a technology-based, lifestyle modification program (intervention) or to enhanced usual care (control). Results The first 10 kidney transplant recipients screened were eligible and randomized into the intervention and control groups with no significant between-group differences at baseline. Health coaching attendance (78%) and adherence to reporting healthy behaviors (86%) were high. All participants returned for final assessments. The weight in controls remained stable, while the intervention arm showed weight gain at 3 and 6 months. Improvements were found for physical activity, quality of life, and fruit and vegetable intake in both groups. All participants would recommend the program to other transplant recipients. Conclusions Our data suggest that a remotely delivered televideo nutrition and physical activity intervention is feasible and valued by patients. These findings will aid in the development of a larger, more prescriptive, randomized trial to address weight gain prevention. Trial registration Clinicaltrials.gov Identifier NCT03697317. Retrospectively registered on October 5, 2018.

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“…Furthermore, weight gain of greater than 15% is associated with increased non-kidney related mortality within 10 years (Vega, Huidobro, De La Barra, & Haro, 2015). Therefore, interventions should target weight gain as a potentially modifiable risk factor for new KTRs (Henggeler et al, 2018). Post-kidney transplant weight gain is multifactorial and may be influenced by increased appetite (Cashion et al, 2014), which can be further exacerbated by immunosuppressant medications (Aksoy, 2016), altered eating behaviours associated with the lifting of dialysis dietary restrictions (Stanfill, Bloodworth, & Cashion, 2012), reduced functional capacity due to preceding uremic myopathy (Koufaki, Greenwood, Macdougall, & Mercer, 2013), and muscle atrophy (Greenwood et al, 2015;Van Den Ham et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

Usability and experience testing to refine an online intervention to prevent weight gain in new kidney transplant recipients

Castle

Greenwood

Chilcot

et al. 2020

British J Health Psychol

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Objectives. Weight gain in the first year following kidney transplantation increases the risk of adverse health outcomes. Currently, there is no recognized intervention available to prevent weight gain after kidney transplantation. An online kidney transplant-specific resource, entitled Exercise in Renal Transplant Online (ExeRTiOn), has been co-created by a multi-professional team, including patients, to assist with weight prevention. This study aimed to evaluate patient and health care professional usability and experience of the ExeRTiOn online resource. Design. Qualitative study utilizing 'Think-Aloud' and semi-structured interviews. Methods. Participants (n = 17) were purposively sampled to include new kidney transplant recipients (n = 11) and transplant health care professionals (n = 6). Kidney transplant recipient participants were from a spread of physical activity levels based on scores from the General Practice Physical Activity Questionnaire (GPPAQ). 'Think-Aloud' interviews assessed the usability of ExeRTiOn. Semi-structured interviews explored participants' experience of ExeRTiOn, weight gain, and physical activity. The data set were analysed thematically. Participant characteristics, including login data and self-reported body weight, were collected. Results. Data analyses identified valued intervention content and usability aspects which were summarized by two themes. The first theme 'You need to know how to manage yourself' included subthemes: (1) the resource filled a guidance gap, (2) expert patient content resonated, and (3) the importance of goal setting and monitoring progress. The second theme 'room for improvement' included subthemes: (2) web support and (2) content and operational change suggestions.

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A Randomized Controlled Trial of an Intensive Nutrition Intervention Versus Standard Nutrition Care to Avoid Excess Weight Gain After Kidney Transplantation: The INTENT Trial

Abstract: Kidney transplant recipients in the first year after transplant did not benefit from an intensive nutrition intervention compared with standard nutrition care, although weight gain was relatively modest in both groups.

Cited by 38 publications

References 56 publications

Obesity After Kidney Transplantation—Results of a KTx360°Substudy

Obesity After Kidney Transplantation—Results of a KTx360°Substudy

Feasibility and acceptability of a televideo physical activity and nutrition program for recent kidney transplant recipients

Usability and experience testing to refine an online intervention to prevent weight gain in new kidney transplant recipients

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