SUCCESSFUL RENAL TRANSPLANTATION IMPROVES NUTRITIONAL STATUS AND EXERCISE TOLERANCE IN HEMODIALYSIS PATIENTS

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Abstract Title

First Name *

DIPANKAR MADHUSUDHAN

Last Name *

BHOWMIK

Co-author 1

MOHD ASLAM draslam8881@gmail.com ALL INDIA INSTITUTE OF MEDICAL SCIENCES NEPHROLOGY New Delhi

Co-author 2

GURDEEP KAUR gur1305@gmail.com ALL INDIA INSTITUTE OF MEDICAL SCIENCES DIETETICS New Delhi

Co-author 3

RAJ KANWAR YADAV rkyadavnephrology@gmail.com ALL INDIA INSTITUTE OF MEDICAL SCIENCES NEPHROLOGY New Delhi

Co-author 4

SANDEEP MAHAJAN mahajansn@gmail.com ALL INDIA INSTITUTE OF MEDICAL SCIENCES NEPHROLOGY New Delhi

Co-author 5

Co-author 6

Co-author 7

Co-author 8

Co-author 9

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

It is known that hemodialysis patients are often malnourished and have reduced exercise tolerance. Successful renal transplantation results in improvement of several physiological parameters. There is not much data regarding change in nutritional status and exercise tolerance post-transplantation. Hence, we performed a single center cohort observational study to assess the above.

Methods

Adults aged 18 years or older were selected. The exclusion criteria included patients with physical disabilities, cardiovascular disease, peripheral vascular disease, myopathy, neuropathy and COPD. 53 patients were recruited into the study. Nutritional assessment included BMI, midarm circumference, triceps skin fold thickness and arm muscular area. All values were compared with standard charts for same age and built. Exercise capacity was tested using the following parameters: Isokinetic dynamometry, 6-minute walk test, STS5 (the time taken to complete 5 sit-to-stand-to-sit cycles), arm curl (number of bends made with supination of the dominant forearm, holding a hand weight of 8 lbs for men and 5 lbs for women, during a period of 30 seconds in a seated position on a chair without backrest. All the tests were repeated three months after successful renal transplantation.

Results

Of the 53 patients, 50 were males and three were females. The average hemodialysis vintage of the patients was 1.5 yrs. The mean age of the patients was 34.1+11.0 years with a BMI of 19.87+2.9 kg/m2. All the nutritional parameters improved significantly following renal transplantation (Table 1). The exercise parameters pre and post transplantation are shown in Table 2, in which too there was marked improvement.

Conclusions

The nutritional status in patients of chronic kidney disease undergoing hemodialysis is markedly worse as compared to the normal individuals of the same age and built. Their exercise tolerance is also markedly reduced. Three months after successful renal transplantation results in significant improvement of both the nutritional status and exercise tolerance

Table 1. Nutritional Parameters Before and After 3 Months of Transplant

Parameter	Pre-Transplant	Post-Transplant	p-value
Total Calories intake (cal/day)	1340.6 + 214.8	1608.7 + 257.2	<0.001
Total protein intake (g/day)	32.17 + 5.04	53.24 + 8.80	<0.001
Hb (g/dl)	9.28 + 1.88	12.11 + 1.13	<0.001
BMI (kg/m2)	19.78 + 2.86	21.13 + 2.92	<0.001
Mid Arm circumference	24.75 + 3.01	28.04 + 3.26	<0.001
Arm muscular Area (mm2)	2738.7 + 805.4	3412.8 + 1053.8	<0.001
Triceps Skin Fold (mm)	19.9 + 5.7	24.7 + 7.5	<0.001

Table 2. Exercise Parameters Before and After 3 Months of Transplant

Parameter	Pre-Transplant	Post-Transplant	p-Value
Partial Pressure of Oxygen (SPO2) (%)	97.3 + 1.9	95.7 + 0.8	<0.001
Dynamometry (Kg)	24.02 + 13.52	32.81 + 13.23	<0.001
6-Minute Walk Test (60 mts.) (No. of rounds)	7.15 + 1.32	10.23 + 1.17	<0.001
Total Distance Walked (mts.)	464.2 + 91.2	620.8 + 104.5	<0.001
Sit to Stand to Sit in 5 sec	10.8 + 2.8	7.2 + 2.8	<0.001
Arm Curl in 30 sec	8.2 + 1.5	11.3 + 1.7	<0.001

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