Metabolic syndrome after kidney transplantation.

Metabolic syndrome (MS) can be linked to the progression of chronic renal transplant dysfunction (CRTD). Hyperfiltration in transplanted patients is a further risk factor for MS and for the progression of CRTD. Many studies show in kidney-transplanted subjects a prevalence of MS at 60% after 6 years posttransplantation. We studied 182 patients (126 men and 56 women) with functioning renal transplant in Messina and Rovigo Renal Units. In our patients we saw at 6 years postkidney transplant in men a prevalence of MS at 20% (NCEPATPIII criteria) or 30% (Rovigo-Messina more strict criteria), and women at 6 years posttransplantation a prevalence of MS at 25% (NCEPATPIII criteria) or 50% (Rovigo-Messina criteria). In our patients, the period of graft function was over 15 years. This result is due to continued follow-up of metabolic parameters and to moderate protein (0.8-0.9 g/kg/day), low lipid, and low caloric intake. These strategies permit the avoidance of hyperfiltration, the reduction of hyperlipidemia and obesity. Special attention is due to women 50-65 years old. In these patients the prevalence of metabolic syndrome 6 years posttransplant is very high (60%). Postmenopausal syndrome is an additional risk factor for MS, atherosclerosis, and the progression of CRTD.

Factors affecting nutritional status, response to exercise, and progression of chronic rejection in kidney transplant recipients.

The nutritional status and the function of a renal graft are satisfactory in kidney transplantation patients who observe their dietary prescription. A reduction in maximal exercise test capacity in kidney transplant recipients are thought to be a consequence of uremic muscle dysfunction and also of changes in muscle structure associated with immunosuppressive therapy. Daily regular physical activity is recommended. Patients with a functioning renal transplant, as well as hemodialyzed patients, have an increased risk for development of cardiovascular diseases such as hypertension, hyperlipidemia, hyperglycemia, and obesity. The reduction of obesity and of cardiovascular risk factors in these patients are goals to be obtained by adequate nutrition, exercise, and physical activity.

Long-term protein intake control in kidney transplant recipients: effect in kidney graft function and in nutritional status.

BACKGROUND: Reduction in renal mass is followed by progressive renal failure. The reduction in filtration surface area, caused by the absence of 50% of renal mass, in patients with customary salt intake is followed by expansion of extracellulary volume and systemic and glomerular hypertension. High protein intake may contribute to renal allograft injury arising from insufficient renal mass. METHODS: The authors studied outcome of 48 patients with kidney transplant to whom normocaloric diets and moderate intake of protein (0.8 g/kg), of sodium (3 g/d), and lipids (no more than 30% of total energy) were prescribed. Monthly 24-hour urea excretion and 24-hour sodium excretion were measured. Renal function was assessed by creatinine clearances and by renal scintigraphy. The 30 patients who followed prescriptions exactly were the compliant group (group 1). The other 18, who followed the diet prescribed only partially (their intakes were 1.4 g/kg of protein and 5 g/d of sodium) were the control group (group 2). RESULTS: Patients of the compliant group maintained unchanged renal function, whereas patients of the control group lost more than 40% of excretion efficiency as a mean. CONCLUSIONS: Dietary restrictions of protein and sodium can stabilize renal function in patients with kidney transplant. Wider use of this treatment is indicated.