Dietary Intake in Early Post Kidney Transplant Recipients And Identied Issues in Nutritional Management Ⅱ

IV. consideration

1. Patients surveyed

The average age of the target patients in this study was 43.0 ± 13.6 years, which is slightly younger than the average age of Japanese kidney transplant patients (47.1 ± 15.2 years for living kidneys, 50.2 ± 14.2 years for donated kidneys)13).

there were. The average age of living donors was 57.1±10.8 years, which was older than the national average (47.1±15.2 years)12). Since 75.0% of all transplanted kidneys had CKD stage 3T or higher, it suggests the importance of lifestyle improvements and dietary therapy aimed at suppressing the progression of CKD in kidney transplant patients, as described below. It was done.

2. Protein and salt intake by engraftment period

JCHO Sendai Hospital provides nutritional guidance to all kidney transplant patients during the induction period. At the outpatient clinic, we work with patients to consider issues related to their individual dietary and exercise habits, and provide ongoing nutritional guidance based on individual physical and nutritional evaluations, tailored to the situation.

In this study, protein intake during the first year after transplantation showed a tendency for men to exceed the dietary standard range for CKD stage G3a (0.8 to 1.0 g/kg/day)14), but women were generally in compliance. It had been. Rho et al. reported that protein intake (g/kg IBW/day) one month after transplantation was 1.6 ± 0.3 for men and 1.4 ± 0.4 for women based on 3-day dietary records of 50 Korean subjects. 15).

On the other hand, Ka plantar-Zadeh et al. recommended a daily protein intake of 0.8 g/kg IBW/day for healthy people and 0.6 g/kg IBW/day for CKD patients7)

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Traditionally, protein intake restrictions have been widely practiced in Japan in the hope of protecting the kidneys, but while the importance of protein intake restrictions has not changed in the guidelines of each country, recent concerns about malnutrition have increased. Therefore, there are many views that a certain amount of protein and energy should be ensured14).

One year after transplantation, salt intake was 11.9 ± 2.9 g/day for men and 8.7 ± 2.3 g/day for women (overall average 10.7 g/day), which was within the CKD diet standard range (less than 3 to 6 g/day) for both men and women. ) was significantly exceeded. However, protein intake by the engraftment period tended to increase from 6 months after transplantation, whereas salt intake tended to decrease. This suggests that the subjects' tastes have become accustomed to lighter flavors, and their body composition suggests an improvement in their eating habits. Regarding salt intake after transplantation, there are reports by Nagaoka et al. 5) and Kitamura et al. 6). Nagaoka et al. found that the average salt intake in their 66 cases was 9.9 ± 3.6 g/day, but this is an estimate based on BDHQ an average of 7 years after transplantation, making it difficult to compare with the present study. be. On the other hand, Kitamura et al. reported that the salt intake (g/day) 1 year after transplantation using the TANA KA formula (occasional urine) was 12 ± 1.84 for men and 8.83 ± 1.97 for women in Japanese subjects. 6). Comparing the results of this study with the results of the present study regarding salt intake one year after transplantation, in men, the present study's result of 11.9 ± 2.9 g/day was 2.78 g/day more than the Kitamura et al.'s result of 9.12 ± 1.84 g/day. However, in women, the amounts were almost the same at 8.83 ± 1.97 g/day and .7 ± 2.3 g/day, respectively.

However, the survey method used in this study was the 24-hour urine collection method, 16), which can be said to be the gold standard method for evaluating urinary sodium excretion.

This is an actual measured value, whereas the previous study used a meal recording method15) or an estimated value using occasional urine), so it is necessary to compare the results based on the premise that the difference in survey method affects each result. I think so. The average salt intake of kidney transplant patients overseas using the 24-hour urine collection method was 9.25 g/day, which was 1.5 g lower than this report17)

Kobayashi et al. found that by providing low-salt food in the company cafeteria in addition to providing information on reducing salt intake, participants' subsequent urinary Na excretion, lower salt taste perception threshold, and lower preferred salt concentration were found by Kobayashi et al. This report18) is considered to be an intervention method that should be attempted in the future. In this study, BMI, muscle mass, and body fat percentage were within the normal range for both men and women one year after transplantation, and nutritional evaluation indicators such as ALB were maintained and improved. Rather than sticking too tightly to the range of standard values for each nutrient, understand the basic concept of nutrient intake, and then adjust according to the situation by referring to treatment guidelines for each comorbid disease and individual physical and nutritional evaluations. I think it is okay to adjust it as appropriate14).

3. Nutritional assessment 1 year after transplantation

One year after the transplant, his body mass index, muscle mass, and body fat percentage were within normal limits for both men and women. In men, BMI, muscle mass, and body fat percentage increased 12 months after transplantation compared to 1 month after transplantation, although there were no significant differences. There is no significant difference in women

Nono's BMI and muscle mass increased, and her body fat percentage tended to decrease. These results suggest that the weight gain of the women in this study during the year after transplantation was mainly due to an increase in muscle mass. Induction phase BMI (kg/

Regarding m2), at admission 23.2±2.5 15), at discharge 24.6±4.2 19), after 1 month 21.7 15), after 3 months 22.1 15), after 6 months 26±4.6 19), after 1 year There have been reports of 26.9 ± 5.4 19), but in both cases, the BMI in this study was lower than in previous studies. An American study on body composition (20) found that patients weighed an average of 3.7 kg more at 12 months than at the time of transplantation. BMI,

Body fat mass also increased significantly, especially in women and African Americans. Fat-free mass, including muscle mass, increased in women although it was not significant, consistent with the results of this study.

On the other hand, research on Asians, who have a different body composition from Caucasians21)

, an average weight gain of 3 kg 12 months after transplantation, a significant decrease in muscle mass, and an increase in body fat have been reported from South Korea. Nagata et al. found that lower limb muscle strength of kidney transplant patients improved significantly at 6 and 12 months after kidney transplantation compared to 3 months after kidney transplantation.

[22], which is consistent with the results of this study. When a person is undernourished, their immune function declines, making them susceptible to infection23)

Her ALB for both men and women one year after transplantation was within the normal range, and the risk of infection due to malnutrition was thought to be low. On the other hand, the reason for the significant increase in TLC in men at 9 and 12 months compared to 3 months post-transplant is thought to be due to the reduction in immunosuppressant medication rather than improved nutritional status. It was done.

In men, his ALB and RBC, Hb, and Ht gradually increased significantly from 3 months after transplantation compared to 1 month after transplantation. A woman's RBC and Hb also increased gradually, but the significant increases were for RBC after her 6 months and for Hb after her 12 months. There was no significant difference in the ALB of women's girlfriends, but the reasons for this include the fact that the number of patients surveyed was smaller than that of men and that their ALB values 1 month after transplantation were higher than those of men. Conceivable. Rho et al.'s report15) showed that his ALB significantly increased from 4.2±0.3 g/dL 1 month after transplantation to 4.4±0.3 g/dL 3 months after transplantation; The results were similar to those of the study.

Four. Significance and limitations of the research

This study is the first report to longitudinally investigate protein and salt intake and nutrition-related indicators during the first year after kidney transplantation in Japan. Protein and salt intake were assessed using a highly accurate 24-hour urine collection method. Therefore, we believe that the results of this study will provide useful information for nutritional management in kidney transplant patients from the induction phase to the maintenance phase. On the other hand, since this study included data only for 1 year after transplantation, further investigation is required regarding long-term nutritional management of kidney transplant patients. In addition, salt and dietary intake are known to vary depending on regional dietary habits, and in order to more accurately understand the salt and dietary intake status of kidney transplant patients, it is necessary to conduct research in different regions than in this study. We believe that a similar investigation is necessary.

V. Conclusion

Protein intake after transplantation increased from 6 months after transplantation, especially in men, who tended to exceed the dietary reference range for CKD stage G3a (0.8-1.0 g/kg/day). Salt intake exceeded his CKD diet reference range (less than 3–6 g/day) for both men and women throughout the period. However, because the nutritional status, immune function, and renal function of kidney transplant patients were maintained and improved during the first year after transplantation, it seems that the protein intake standards within the first year after transplantation are too rigid within the range of reference values for each stage. After understanding the basic concept of intake of each nutrient, we believe that it is okay to make adjustments as appropriate depending on the situation, with reference to treatment guidelines for each comorbid disease and individual physical and nutritional evaluations. Regarding salt intake, since 79 out of 100 patients were taking antihypertensive drugs, we believe that the goal should be within the CKD diet standard range (less than 3 to 6 g/day). However, since it is not easy to change traditional eating habits and food consciousness, it may affect patients' appetite, preferences, and QOL (quality of life).

Continuous and considerate support is necessary.

Acknowledgment

We would like to express our deepest gratitude to the late Dr. Noritoshi Amada of the Department of Surgery at JCHO Sendai Hospital for his guidance in this research.

There is nothing to declare as a conflict of interest.

Reference

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