Protein and calorie restriction may improve outcomes in living kidney donors and kidney transplant recipients

Abstract

Previously, we and others showed that dietary restriction protects against renal ischemia-reperfusion injury in animals. However, clinical translation of preoperative diets is scarce, and in the setting of kidney transplantation these data are lacking. In this pilot study, we investigated the effects of five days of a preoperative protein and caloric dietary restriction (PCR) diet in living kidney donors on the perioperative effects in donors, recipients and transplanted kidneys. Thirty-five kidney donors were randomized into either the PCR, 30% calorie and 80% protein reduction, or control group without restrictions. Adherence to the diet and kidney function in donors and their kidney recipients were analyzed. Perioperative kidney biopsies were taken in a selected group of transplanted kidneys for gene expression analysis. All donors adhered to the diet. From postoperative day 2 up until month 1, kidney function of donors was significantly better in the PCR-group. PCR-donor kidney recipients showed significantly improved kidney function and lower incidence of slow graft function and acute rejection. PCR inhibited cellular immune response pathways and activated stress-resistance signaling. These observations are the first to show that preoperative dietary restriction induces postoperative recovery benefits in humans and may be beneficial in clinical settings involving ischemia-reperfusion injury.

Short-Term Pre-Operative Protein Caloric Restriction in Elective Vascular Surgery Patients: A Randomized Clinical Trial

“…Pre-operative PCR specifically performed in living kidney donors in order to enhance recipient kidney function has previously been shown to be safe and feasible [43]. More recently, a follow-up study pointed towards improved kidney function after transplantation [44]. Excitingly, this implicates a role for PCR beyond vascular surgery, which could potentially improve patient outcomes across many fields, resulting in better healthcare outcomes and lower costs for patients and hospitals.…”

Intermittent fasting in paediatric critical illness: The properties and potential beneficial effects of an overnight fast in the PICU

“…Furthermore, fasting has shown to reduce tissue damage, improve functional outcome, and mitigate cognitive deficits in a murine model of traumatic injury to head or spine [113,121e123]. Also in a clinical setting involving human ischemiareperfusion injury after kidney transplantation, preoperative dietary restriction improved postoperative recovery [124]. Most of these studies have used fasting as preconditioning feature.…”

Dietary Restriction for Kidney Protection: Decline in Nephroprotective Mechanisms During Aging

“…Eventually, DR has shown impressive effectiveness in the treatment of experimental kidney pathologies, which makes it possible to translate this approach into clinical practice, especially in conditions when the risk of AKI is increased, for example, during cardiac surgery ( Grundmann et al, 2018 ). In addition, DR improves transplant outcomes from young donors by reducing ischemic damage during transplantation ( van Ginhoven et al, 2011 ; Jongbloed et al, 2020 ). To improve kidney function, a low-calorie or ketogenic diet is recommended for people with obesity accompanied by mild renal insufficiency ( Bruci et al, 2020 ).…”