- Email: [email protected]
Increase in Body Mass Index After Renal Transplantation
Increase in Body Mass Index After Renal Transplantation E. Uysala,*, M.F. Yuzbasioglua, H. Bakirb, O.A. Gurerb, A.M. Ikidagc, and M. Dokurd a Transplantation Center, Sanko University Hospital, Gaziantep, Turkey; bDepartment of General Surgery, Sanko University Hospital, Gaziantep, Turkey; cDepartment of Radiology, Sanko University Hospital, Gaziantep, Turkey; and dDepartment of Emergency, Sanko University Hospital, Gaziantep, Turkey
ABSTRACT The aim of this study was to determine the changes in body mass index (BMI) of patients after renal transplantation regarding causes like steroid use, lower necessity for dietary restrictions, and changes in eating habits. Ninety-seven patients were enrolled in this retrospective study; they had undergone cadaver or living donor renal transplantation between 2011 and 2013. Demographic features of patients, height, weight, and BMI were evaluated before and 6 and 12 months after surgery. The patients were grouped as malnutritioned, normal, overweight, and obese. Statistical analyses were performed using the SPSS 11.0 statistics program. Mean age of patients was 39.1 10.7 years. Twenty-six (26.8%) were female and 71 (73.1%) were male. Mean BMI before surgery was 22.52 3.97 kg/m2. Six months post-transplantation the mean BMI was 24.40 4.1 kg/m2 and after 12 months it was 25.56 4.14 kg/m2 (P < .05). Also, 68% of patients showed improvement 12 months after surgery; they were in the preoperative malnutrition group. There is a significant increase in the BMI of patients in the first year who undergo renal transplantation, and the reason is multifactorial. BMI is relevant to diabetes, hypertension, and allograft nephropathy. BMI should be carefully considered in the follow-up of patients who have undergone renal transplantation, and early nutritional changes with dietary and exercise programs should be performed in overweight cases.
W
EIGHT gain is frequently encountered in patients after renal transplantation. Although it has many reasons, steroids, immunosuppressive medications, and resolution of chronic disease are mostly held responsible [1]. Patients take more calories and have a change of eating habits, especially due to increased appetite and lower necessity for dietary restrictions [2]. Being overweight is related to hypertension, dyslipidemia, and diabetes, and it increases mortality and morbidity due to cardiovascular diseases [3]. The aim of this study was to determine the changes in body mass index (BMI) of patients after renal transplantation.
files were analyzed using SPSS 11.0 for Windows statistical software. Data was presented as the mean standard deviation (SD). P < .05 was accepted as significant.
RESULTS
MATERIALS AND METHODS
Mean age of patients was 39.1 10.7 years. Twenty-six (26.8%) were female and 71 (73.1%) were male. Fifty-five (56.7%) of the patients had cadaver renal transplantation, whereas 42 (43.2%) of the patients had living donor renal transplantation (Table 1). Mean BMI before surgery was 22.52 3.97 kg/m2. Six months post-transplantation mean BMI was 24.40 4.1 and after 12 months it was 25.56 4.14 kg/m2 (P < .05). Also, 68% of patients showed improvement after 12 months of
Ninety-seven patients were enrolled in this retrospective study; the patients underwent cadaver or living donor renal transplantation between 2011 and 2013. Demographic features of patients, height, weight, and BMI were evaluated before and 6 and 12 months after surgery. The patients were grouped as malnutritioned, normal, overweight, and obese. The data obtained via analysis of the patient
*Address correspondence to Erdal Uysal, MD, Sanko University Transplantation Center, Incilipinar Mah. Ali Fuat Cebesoy Bulv. No: 45 27090, Sehitkamil - Gaziantep, Turkey. E-mail: [email protected]
0041-1345/15 http://dx.doi.org/10.1016/j.transproceed.2015.04.028
ª 2015 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710
1402
Transplantation Proceedings, 47, 1402e1404 (2015)
BODY MASS INDEX
1403
Table 1. Demographic Features and Major Clinical Events n (%)
Total transplantations (n) Recipient age Recipient gender Male Female Donor Living Cadaveric Major clinical events Acute rejection Chronic rejection Infection Early Late Recurrence of original disease Patient died
97 39.1 10.7* 71 (73.1) 26 (26.8) 42 (43.2) 55 (56.7) 2 (2) 1 (1) 4 11 2 1
(4.1) (11.3) (2) (1)
*Data are presented as mean SD.
surgery; they were in the preoperative malnutrition group (Table 2). There were no difference between cadaver and living donor transplant recipients regarding comparison of BMI changes after 6 and 12 months (P > .05). The least BMI was 16 kg/m2 and the greatest was 34.35 kg/m2 before surgery. Preoperatively, 16 patients had BMI <19 kg/m2, and they were considered to be the low weight, malnutritioned group. The BMI of 2 patients found to be normal 12 months after transplantation were in the obese group before operation. DISCUSSION
After renal transplantation, weight gain is usual both in normal and obese recipients [2], and the cause is multifactorial. Although it has many reasons, steroids, immunosuppressive medications, and resolution of chronic disease are mostly held responsible [1]. In a previous study, weight gain was also found in patients who did not receive steroid medication and it was suggested that steroids alone should not be accused for postoperative weight gain [3,4]. Returning to normal daily life, changes in eating habits, and lower necessity for dietary restrictions may responsible for weight gain [5].
Table 2. MDRD eGFR Values and BMI Rate Pretransplantation 2
BMI (kg/m ) MDRD eGFR (mL/min/1.73 m2) Least BMI (kg/m2) Greatest BMI (kg/m2)
22.52 3.97
16 34.3
Month 6
Month 12
24.4 4.1 25.56 4.14 55.6 18.1 54 15 18.2 35.6
19 35.8
Note. Data are presented as mean SD. Abbreviations: MDRD, modification of the diet in renal disease; eGFR, estimated glomerular filtration rate.
In a previous study, it was shown that the vast majority of weight gain was in the first postoperative year in patients who have undergone renal transplantation; the patients were followed up for 5 years, and immunosuppressive medication was blamed [1]. In another study it was found that being a young and female recipient, receiving a donation from a younger donor, and creatinine levels were correlated with significant weight gain especially after the 36th month after transplantation [3]. Our results of first year follow-up were consistent with previous studies that were published in the literature, but longterm follow-up and analysis of these findings are necessary. Excess weight gain is related to cardiovascular diseases and causes significant mortality and morbidity. Because some patients with end-stage renal failure also have accompanying hypertension and diabetes, their weights and BMI should be closely monitored after transplantation. A recent study revealed that obesity incidence increases in the third year after renal transplantation. It is also found that blood pressures and need for antihypertensive medication are higher in obese recipients [6]. It is shown that an increase in BMI is highly correlated with post-transplantation diabetes mellitus development and BMI increase is a significant risk factor for diabetes [7,8]. Also it is depicted that glomerular filtration rate is reduced by an increase of BMI at 6 months after surgery [9]. Another study revealed a relationship between chronic allograft nephropathy and BMI increase in the first year after surgery, and emphasized that BMI increase causes diabetes, hypertension, and hyperlipidemia [10]. Patients who have postsurgical excessive weight gain should receive the following recommendations: regular exercise, inclusion in a dietary program, and steroid reduction. Early interventions will reduce complication rates [2]. In conclusion, there is a significant increase in the BMI of patients in the first year after renal transplantation, and the reason is multifactorial. BMI is relevant to diabetes, hypertension, and allograft nephropathy. BMI should be carefully considered in the follow-up of patients who underwent renal transplantation, and early nutritional changes with dietary and exercise programs should be performed in overweight cases.
REFERENCES [1] Fernandez Castillo R, Fernandez Gallegos R, Esteban de la Rosa RJ, Pena Amaro MP. Longitudinal study of weight and body mass index after renal transplantation during 5 years of evolution. Nutr Hosp 2014;30:287e92. [2] Costa B, Moratelli L, Silva LB, Paiva AC, Silva AN, Carminatti M, et al. Body mass index in the first year after kidney transplantation. Transplant Proc 2014;46:1750e2. [3] Oliveira CM, Moura AE, Gonçalves L, Pinheiro LS, Pinheiro Jr FM, Esmeraldo RM. Post-transplantation weight gain: prevalence and the impact of steroid-free therapy. Transplant Proc 2014;46:1735e40. [4] Wittenhagen P, Thiesson HC, Baudier F, Pedersen EB, Neland M. Long-term experience of steroid-free pediatric renal
1404 transplantation: effects on graft function, body mass index, and longitudinal growth. Pediatr Transplant 2014;18:35e41. [5] Bloodworth RF, Ward KD, Relyea GE, Cashion AK. Food availability as a determinant of weight gain among renal transplant recipients. Res Nurs Health 2014;37:253e9. [6] Ruangkanchanasetr P, Satirapoj B, Bunnag S, Vongwiwatana A, Premasathian N, Avihingsanon Y. High prevalence of obesity in Thai renal transplant recipients: a multicenter study. Transplant Proc 2014;46:546e51. [7] Tokodai K, Amada N, Kikuchi H, Haga I, Takayama T, Nakamura A. Posttransplant increase of body mass index is
UYSAL, YUZBASIOGLU, BAKIR ET AL associated with new-onset diabetes mellitus after kidney transplantation. Tohoku J Exp Med 2013;229:227e32. [8] Gosmanov AR, Dagogo-Jack S. Predicting, managing and preventing new-onset diabetes after transplantation. Minerva Endocrinol 2012;37:233e46. [9] Netto MC, Alves-Filho G, Mazzali M. Nutritional status and body composition in patients early after renal transplantation. Transplant Proc 2012;44:2366e8. [10] Wang K, Liu QZ. Effect analysis of 1-year posttransplant body mass index on chronic allograft nephropathy in renal recipients. Transplant Proc 2011;43:2592e5.
ABSTRACT The aim of this study was to determine the changes in body mass index (BMI) of patients after renal transplantation regarding causes like steroid use, lower necessity for dietary restrictions, and changes in eating habits. Ninety-seven patients were enrolled in this retrospective study; they had undergone cadaver or living donor renal transplantation between 2011 and 2013. Demographic features of patients, height, weight, and BMI were evaluated before and 6 and 12 months after surgery. The patients were grouped as malnutritioned, normal, overweight, and obese. Statistical analyses were performed using the SPSS 11.0 statistics program. Mean age of patients was 39.1 10.7 years. Twenty-six (26.8%) were female and 71 (73.1%) were male. Mean BMI before surgery was 22.52 3.97 kg/m2. Six months post-transplantation the mean BMI was 24.40 4.1 kg/m2 and after 12 months it was 25.56 4.14 kg/m2 (P < .05). Also, 68% of patients showed improvement 12 months after surgery; they were in the preoperative malnutrition group. There is a significant increase in the BMI of patients in the first year who undergo renal transplantation, and the reason is multifactorial. BMI is relevant to diabetes, hypertension, and allograft nephropathy. BMI should be carefully considered in the follow-up of patients who have undergone renal transplantation, and early nutritional changes with dietary and exercise programs should be performed in overweight cases.
W
EIGHT gain is frequently encountered in patients after renal transplantation. Although it has many reasons, steroids, immunosuppressive medications, and resolution of chronic disease are mostly held responsible [1]. Patients take more calories and have a change of eating habits, especially due to increased appetite and lower necessity for dietary restrictions [2]. Being overweight is related to hypertension, dyslipidemia, and diabetes, and it increases mortality and morbidity due to cardiovascular diseases [3]. The aim of this study was to determine the changes in body mass index (BMI) of patients after renal transplantation.
files were analyzed using SPSS 11.0 for Windows statistical software. Data was presented as the mean standard deviation (SD). P < .05 was accepted as significant.
RESULTS
MATERIALS AND METHODS
Mean age of patients was 39.1 10.7 years. Twenty-six (26.8%) were female and 71 (73.1%) were male. Fifty-five (56.7%) of the patients had cadaver renal transplantation, whereas 42 (43.2%) of the patients had living donor renal transplantation (Table 1). Mean BMI before surgery was 22.52 3.97 kg/m2. Six months post-transplantation mean BMI was 24.40 4.1 and after 12 months it was 25.56 4.14 kg/m2 (P < .05). Also, 68% of patients showed improvement after 12 months of
Ninety-seven patients were enrolled in this retrospective study; the patients underwent cadaver or living donor renal transplantation between 2011 and 2013. Demographic features of patients, height, weight, and BMI were evaluated before and 6 and 12 months after surgery. The patients were grouped as malnutritioned, normal, overweight, and obese. The data obtained via analysis of the patient
*Address correspondence to Erdal Uysal, MD, Sanko University Transplantation Center, Incilipinar Mah. Ali Fuat Cebesoy Bulv. No: 45 27090, Sehitkamil - Gaziantep, Turkey. E-mail: [email protected]
0041-1345/15 http://dx.doi.org/10.1016/j.transproceed.2015.04.028
ª 2015 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710
1402
Transplantation Proceedings, 47, 1402e1404 (2015)
BODY MASS INDEX
1403
Table 1. Demographic Features and Major Clinical Events n (%)
Total transplantations (n) Recipient age Recipient gender Male Female Donor Living Cadaveric Major clinical events Acute rejection Chronic rejection Infection Early Late Recurrence of original disease Patient died
97 39.1 10.7* 71 (73.1) 26 (26.8) 42 (43.2) 55 (56.7) 2 (2) 1 (1) 4 11 2 1
(4.1) (11.3) (2) (1)
*Data are presented as mean SD.
surgery; they were in the preoperative malnutrition group (Table 2). There were no difference between cadaver and living donor transplant recipients regarding comparison of BMI changes after 6 and 12 months (P > .05). The least BMI was 16 kg/m2 and the greatest was 34.35 kg/m2 before surgery. Preoperatively, 16 patients had BMI <19 kg/m2, and they were considered to be the low weight, malnutritioned group. The BMI of 2 patients found to be normal 12 months after transplantation were in the obese group before operation. DISCUSSION
After renal transplantation, weight gain is usual both in normal and obese recipients [2], and the cause is multifactorial. Although it has many reasons, steroids, immunosuppressive medications, and resolution of chronic disease are mostly held responsible [1]. In a previous study, weight gain was also found in patients who did not receive steroid medication and it was suggested that steroids alone should not be accused for postoperative weight gain [3,4]. Returning to normal daily life, changes in eating habits, and lower necessity for dietary restrictions may responsible for weight gain [5].
Table 2. MDRD eGFR Values and BMI Rate Pretransplantation 2
BMI (kg/m ) MDRD eGFR (mL/min/1.73 m2) Least BMI (kg/m2) Greatest BMI (kg/m2)
22.52 3.97
16 34.3
Month 6
Month 12
24.4 4.1 25.56 4.14 55.6 18.1 54 15 18.2 35.6
19 35.8
Note. Data are presented as mean SD. Abbreviations: MDRD, modification of the diet in renal disease; eGFR, estimated glomerular filtration rate.
In a previous study, it was shown that the vast majority of weight gain was in the first postoperative year in patients who have undergone renal transplantation; the patients were followed up for 5 years, and immunosuppressive medication was blamed [1]. In another study it was found that being a young and female recipient, receiving a donation from a younger donor, and creatinine levels were correlated with significant weight gain especially after the 36th month after transplantation [3]. Our results of first year follow-up were consistent with previous studies that were published in the literature, but longterm follow-up and analysis of these findings are necessary. Excess weight gain is related to cardiovascular diseases and causes significant mortality and morbidity. Because some patients with end-stage renal failure also have accompanying hypertension and diabetes, their weights and BMI should be closely monitored after transplantation. A recent study revealed that obesity incidence increases in the third year after renal transplantation. It is also found that blood pressures and need for antihypertensive medication are higher in obese recipients [6]. It is shown that an increase in BMI is highly correlated with post-transplantation diabetes mellitus development and BMI increase is a significant risk factor for diabetes [7,8]. Also it is depicted that glomerular filtration rate is reduced by an increase of BMI at 6 months after surgery [9]. Another study revealed a relationship between chronic allograft nephropathy and BMI increase in the first year after surgery, and emphasized that BMI increase causes diabetes, hypertension, and hyperlipidemia [10]. Patients who have postsurgical excessive weight gain should receive the following recommendations: regular exercise, inclusion in a dietary program, and steroid reduction. Early interventions will reduce complication rates [2]. In conclusion, there is a significant increase in the BMI of patients in the first year after renal transplantation, and the reason is multifactorial. BMI is relevant to diabetes, hypertension, and allograft nephropathy. BMI should be carefully considered in the follow-up of patients who underwent renal transplantation, and early nutritional changes with dietary and exercise programs should be performed in overweight cases.
REFERENCES [1] Fernandez Castillo R, Fernandez Gallegos R, Esteban de la Rosa RJ, Pena Amaro MP. Longitudinal study of weight and body mass index after renal transplantation during 5 years of evolution. Nutr Hosp 2014;30:287e92. [2] Costa B, Moratelli L, Silva LB, Paiva AC, Silva AN, Carminatti M, et al. Body mass index in the first year after kidney transplantation. Transplant Proc 2014;46:1750e2. [3] Oliveira CM, Moura AE, Gonçalves L, Pinheiro LS, Pinheiro Jr FM, Esmeraldo RM. Post-transplantation weight gain: prevalence and the impact of steroid-free therapy. Transplant Proc 2014;46:1735e40. [4] Wittenhagen P, Thiesson HC, Baudier F, Pedersen EB, Neland M. Long-term experience of steroid-free pediatric renal
1404 transplantation: effects on graft function, body mass index, and longitudinal growth. Pediatr Transplant 2014;18:35e41. [5] Bloodworth RF, Ward KD, Relyea GE, Cashion AK. Food availability as a determinant of weight gain among renal transplant recipients. Res Nurs Health 2014;37:253e9. [6] Ruangkanchanasetr P, Satirapoj B, Bunnag S, Vongwiwatana A, Premasathian N, Avihingsanon Y. High prevalence of obesity in Thai renal transplant recipients: a multicenter study. Transplant Proc 2014;46:546e51. [7] Tokodai K, Amada N, Kikuchi H, Haga I, Takayama T, Nakamura A. Posttransplant increase of body mass index is
UYSAL, YUZBASIOGLU, BAKIR ET AL associated with new-onset diabetes mellitus after kidney transplantation. Tohoku J Exp Med 2013;229:227e32. [8] Gosmanov AR, Dagogo-Jack S. Predicting, managing and preventing new-onset diabetes after transplantation. Minerva Endocrinol 2012;37:233e46. [9] Netto MC, Alves-Filho G, Mazzali M. Nutritional status and body composition in patients early after renal transplantation. Transplant Proc 2012;44:2366e8. [10] Wang K, Liu QZ. Effect analysis of 1-year posttransplant body mass index on chronic allograft nephropathy in renal recipients. Transplant Proc 2011;43:2592e5.