Evolution of body composition following successful kidney transplantation is strongly influenced by physical activity: results of the CORPOS study

Karine Moreau,Rodolphe Thiébaut,Pierre Merville,Christine Germain,Lionel Couzi,Aurélie Desseix,Philippe Chauveau

doi:10.1186/s12882-020-02214-9

Abstract

BackgroundWeight gain (mainly gain of fat mass) occurs quickly after successful kidney transplantation and is associated with metabolic complications (alterations of glycaemic control, hyperlipidaemia). Determinants of weight gain are multifactorial and are mainly related to the transplant procedure itself (glucocorticoid use, increased appetite). In the modern era of transplantation, one challenge is to limit these metabolic alterations by promoting gain of muscle mass rather than fat mass. This prospective study was performed to assess determinants of fat mass, fat-free mass and body cell mass changes after kidney transplantation with a focus on physical activity and nutritional behaviour before and after transplantation.MethodsPatients were included at the time of listing for deceased donor kidney transplantation. Body composition was determined using dual X-ray absorptiometry and bioimpedance spectroscopy to assess fat mass, fat-free mass and body cell mass (= fat-free mass − extracellular water) at the time of inclusion, 12 months later, and 1, 6, 12 and 24 months after transplantation. Recall dietary data and physical activity level were also collected.ResultsEighty patients were included between 2007 and 2010. Sixty-five had a complete 24-month follow-up after kidney transplantation. Fat mass, fat-free mass and body cell mass decreased during the waiting period and early after kidney transplantation. The nadirs of body cell mass and fat-free mass occurred at 1 month and the nadir for fat mass occurred at 6 months. Maximum levels of all parameters of body composition were seen at 12 months, after which body cell mass and fat-free mass decreased, while fat mass remained stable. In multivariate analysis, male recipients, higher physical activity level and lower corticosteroid dose were significantly associated with better body cell mass recovery after kidney transplantation.ConclusionsLifestyle factors, such as physical activity level, together with low dose of corticosteroids seem to influence body composition evolution following kidney transplantation with recovery of body cell mass. Specific strategies to promote physical activity in kidney transplant recipients should be provided before and after kidney transplantation.

Highlights

Weight gain occurs quickly after successful kidney transplantation and is associated with metabolic complications
Fat-free mass remains stable or increases slightly [2,3,4]. The consequences of these body composition changes are not yet clear. They have been reported to be associated with higher prevalence rates of hypertension and diabetes [5] or dyslipidaemia [6], which may explain the elevated risk of death-censored graft loss and death with a functioning graft observed in obese kidney transplant recipients (KTR) [5, 7]
We demonstrated previously that in French patients waiting for kidney transplantation, body composition was altered despite satisfactory classical nutritional markers [9]

Summary

Introduction

Weight gain (mainly gain of fat mass) occurs quickly after successful kidney transplantation and is associated with metabolic complications (alterations of glycaemic control, hyperlipidaemia). In the modern era of transplantation, one challenge is to limit these metabolic alterations by promoting gain of muscle mass rather than fat mass This prospective study was performed to assess determinants of fat mass, fat-free mass and body cell mass changes after kidney transplantation with a focus on physical activity and nutritional behaviour before and after transplantation. Of weight at the time of KT, weight gain after KT is a well-known side effect of successful kidney transplantation It occurs quickly in the first months after transplantation, and is mainly related to an increase in fat mass. Fat-free mass remains stable or increases slightly [2,3,4] The consequences of these body composition changes are not yet clear. We demonstrated previously that in French patients waiting for kidney transplantation, body composition was altered despite satisfactory classical nutritional markers [9]

Methods

Results

Conclusion