Protein Intake, Fatigue and Quality of Life in Stable Outpatient Kidney Transplant Recipients

Abstract

Fatigue is a frequent complaint in kidney transplant recipients (KTR), often accompanied by poor quality of life (QoL). The role of nutrition as determinant of fatigue in KTR is largely unexplored. The aims of this study are to examine the association of protein intake with fatigue and QoL in KTR and to identify other determinants of fatigue. This cross-sectional study is part of the TransplantLines Cohort and Biobank Study (NCT03272841). Protein intake was calculated from urinary urea nitrogen (UUN) in 24-h urine samples. Fatigue was assessed by the Checklist Individual Strength (CIS) questionnaire; moderate and severe fatigue were defined as a CIS score of 20–34 and ≥ 35, respectively. QoL was assessed with the RAND-36-Item Health Survey (RAND-36). Associations of protein intake with fatigue and QoL were analyzed using multinomial logistic and linear regression analyses. We included 730 stable outpatient KTR (median age 58 year [IQR 48–65], 57% male) with a mean protein intake of 82.2 ± 21.3 g/d. Moderate and severe fatigue were present in 254 (35%) and 245 (34%) of KTR. Higher protein intake was significantly associated with lower risk of moderate fatigue (OR 0.89 per 10 g/d; 95%CI 0.83–0.98, p = 0.01), severe fatigue (OR 0.85; 95%CI 0.78–0.92, p < 0.001) and was associated with higher physical component summary score of QoL (β 0.74 per 10 g/d; 95%CI 0.39–1.09, p < 0.001). Higher BMI, a history of dialysis, glomerulonephritis as primary kidney disease and a history of combined organ transplantation were also associated with severe fatigue. In conclusion, amongst the potential modifiable factors of fatigue, higher protein intake is independently associated with lower risk of moderate and severe fatigue and with better QoL in KTR. These findings underline the need to incorporate nutritional assessment in the diagnostic work-up of fatigue. Intervention studies are needed to assess the benefits and safety of higher protein intake in KTR.

Association Between Dietary Quality and Serum Cystatin C in Kidney Transplant Recipients Based on Chinese Diet Balance Index 2016 (DBI-16)

“…Finally, the people we investigated generally did not eat a lot of beans, dairy products, or fish, and their main source of protein was red meat. However, inadequate protein intake, increased nutritional losses, inflammation, oxidative stress, and anabolic or catabolic disorders have been found to lead to high glomerular filtration rates and abnormal kidney function [ 38 – 40 ]. The association of meat foods and cystatin C may be attributed to changes in circadian rhythms or hormonal effects of diet.…”

Muscle mass, muscle strength and mortality in kidney transplant recipients: results of the TransplantLines Biobank and Cohort Study

“… 7 This low number implies that either we are not looking at sarcopenia (or not fully) or maybe the proposed cut‐offs for the diagnosis of sarcopenia are not suitable for the KTR population. Our group recently reported that low muscle mass is a predominant criterion for the diagnosis of malnutrition, 13 and lower protein intake is associated with severe fatigue, lower quality of life, and graft loss and mortality in KTR, 34 , 35 which suggests there is at least a nutritional component at play.…”

Airflow Limitation, Fatigue, and Health-Related Quality of Life in Kidney Transplant Recipients

“…Fatigue was assessed using the checklist individual strength 20 revised (CIS20-R), where the subscore of fatigue severity was used (19). Moderate and severe fatigue were defined as scores ≥20 and ≥35, respectively (20,21). To assess HRQoL, a Dutch translation of the Short Form-36 Health Survey was used.…”