Nutrition Disturbances and Metabolic Complications in Kidney Transplant Recipients: Etiology, Methods of Assessment and Prevention—A Review

Abstract

Nutrition disturbances occur at all stages of chronic kidney disease and progress with the decrease of the kidney filtration rate. Kidney transplantation (KTx) as the best form of kidney replacement therapy poses various nutritional challenges. Prior to transplantation, recipients often present with mild to advanced nutrition disturbances. A functioning allograft not only relieves uremia, acidosis, and electrolyte disturbances, but also resumes other kidney functions such as erythropoietin production and vitamin D3 metabolism. KTx recipients represent a whole spectrum of undernutrition and obesity. Since following transplantation, patients are relieved of most dietary restrictions and appetite disturbances; they resume old nutrition habits that result in weight gain. The immunosuppressive regimen often predisposes them to dyslipidemia, glucose intolerance, and hypertension. Moreover, most recipients present with chronic kidney graft disease at long-term follow-ups, usually in stages G2–G3T. Therefore, the nutritional status of KTx patients requires careful monitoring. Appropriate dietary and lifestyle habits prevent nutrition disturbances and may improve kidney graft function. Despite many nutritional guidelines and recommendations targeted at chronic kidney disease, there are few targeted at KTx recipients. We aimed to provide a brief review of nutrition disturbances and known nutritional recommendations for kidney transplant recipients based on the current literature and dietary trends.

Progress of new-onset diabetes after liver and kidney transplantation

“…The main ways fornutrition interventions is to prevent or treat malnutrition by ensuring adequate macronutrient and micronutrient intake and to decrease malabsorption and maldigestion ( 116 ). Maintaining nutrition balance is crucial in order to minimize the risk of cardiovascular events and metabolic complications in the kidney transplantation population ( 117 ).There is evidence that the preoperative optimization of the nutritional can improvement of short-term outcomes after liver transplantation ( 118 )…”

Fueling the success of transplantation through nutrition: recent insights into nutritional interventions, their interplay with gut microbiota and cellular mechanisms

“…As the kidney is a key organ in maintaining the body's homeostasis, dietary adaptions are frequently needed, i.e. to address common protein energy wasting that summarizes the exhaustion of energy supplies and is present in approximately one third of dialysis patients [8,[77][78][79][80].…”

“…New onset diabetes after transplantation is present in 10-45% of solid organ recipients and major cardiovascular events as well as cardiovascular mortality are significantly increased [87,88,90,91]. Pre-transplantation risk factors include BMI > kg/ m 2 , age > 40 years, a family history of diabetes mellitus in addition to pre-existing diseases such as cystic fibrosis, polycystic kidney disease, hepatitis C and cytomegaly virus infections [79,92]. Other risk factors include deceased donors, the degree of human leucocyte antigen mismatch and acute rejection [8].…”

“…In this context, HDL may slightly decrease, whereas triglyceride-rich VDL and LVDL particles strongly increase causing atherosclerosis [104,105]. Therefore, solid organ recipients are usually recommended to adhere to a low-fat and low-cholesterol diet [79,95]. In line with the dietary recommendation for the new onset diabetes after transplantation, patients with dyslipidemia should follow a high-fiber diet.…”

Immunosuppressive Therapy and Nutritional Status of Patients after Kidney Transplantation: A Protocol for a Systematic Review

“…It is well-documented that proper nutritional status of kTx patients can enhance the outcome of a successful transplant and improve patients' survival. Additionally, it serves as an important indicator of an individual's overall health and quality of their life [29]. As the opposite, inadequate nutrition or a suboptimal nutritional status can compromise the immune system's function, potentially leading to complications and graft rejection.…”