Abstract
Abstract Background and Aims Protein-energy wasting (PEW) is commonly seen among uremic patients, which may still exist after they received kidney transplantation,[1,2] and it is a determining factor in the progression of chronic kidney disease (CKD).[3] The use of immunosuppressants and glucocorticoids after transplantation will also affect the patients' metabolism and aggravate their malnutrition.[4,5] Adequate daily protein intake (DPI) in the early posttransplant period facilitates the rapid recovery of surgical wounds.[6] However, few studies focused on the impact of DPI on the early recovery of graft function. This study aimed to explore the relationship between DPI and graft function at month 3 posttransplant, which may provide a basis for clinical nutritional regimen of kidney transplant recipients. Method This is a retrospective observational study. 176 kidney transplant recipients (KTRs) who underwent kidney transplant in West China Hospital from December 2021 to June 2022 were included and followed up regularly. 24-hour urine urea data were collected at month 3 posttransplant to calculate their DPI. These KTRs were further divided into two groups according to the recommended DPI for KTRs by the 2021 Practice Guidelines for the Nutritional Management of Chronic Kidney Disease,[7] namely high intake group (Group 1, with DPI ≥ 1.4g/kg·d, n = 66) and low intake group (Group 2, with DPI < 1.4g/kg·d, n = 110). Laboratory data and posttransplant adverse events within 3 months were recorded. Multiple logistic regression was used to analyze the relationship between DPI and early posttransplant graft function. Results Mean DPI levels at month 3 posttransplant were 1.75±0.56 g/kg·d in Group 1 and 0.98±0.24 g/kg·d in Group 2, respectively. There was no significant difference in age, gender, pretransplant body mass index (BMI), dialysis type and time, donor type, or the ratio of delayed graft function (DGF) between the two groups. The levels of estimated glomerular filtration rate (eGFR), body mass index(BMI), hemoglobin (Hb), high-density lipid-cholesterol (HDL), and urinary protein at month 3 posttransplant in Group 1 were significantly higher than those in Group 2 (P < 0.005, Fig. 1). No statistical difference was found in the incidence of adverse events between the two groups at month 3 posttransplant. The results of multiple logistic regression analysis showed that higher DPI in the early posttransplant period was a protective factor for graft function after kidney transplantation. Conclusion In the early posttransplant period, higher dietary protein intake (DPI ≥ 1.4 g/kg·d) may improve graft kidney function, lipid metabolism, and renal anemia.
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