Graft function and nutritional parameters in stable post renal transplant patients

Bioelectrical Impedance Analysis (BIA) is a noninvasive and bedside tool for assessment of nutritional status. It is expected that patients who have undergone successful renal transplant will have good nutritional intake and steadily the patient will return to normal health and have good nutritional status.

Objective

The aim of the study was to evaluate effect of graft function on nutritional status in post renal transplant patients with borderline to good allograft function using BIA.

Material and methods

For this study, 45 post-renal transplant patients with mean serum creatinine 1.42 ± 0.42 mg% and glomerular filtration rate (GFR) 45.1 ± 14.1 ml/min were subjected to bioimpedance analysis. Several parameters were evaluated. Based on BIA derived GFR, patients were divided into two groups (group 1: borderline graft function GFR < 40 ml/min, X = 27.34 ± 9.1 ml/min and group 2: good graft function GFR ≥ 40 ml/min, X = 51.60 ± 9.16 ml/min). Patient data were compared with 30 healthy individuals.

Results

There was significant difference between healthy controls and the post transplant patients. Based on GFR, there was significant difference in patient groups in body weight (p = 0.01), serum creatinine (p = 0.005), BMI (p = 0.000), fat free mass (p = 0.003), fat mass (p = 0.003), body cell mass (p = 0.000), dry weight (p = 0.001). Patients with borderline GFR had higher serum creatinine but significantly lower body weight, BMI, FFM, FM, and dry weight, indicating poorer nutritional status as compared to those with good graft function. Based on phase angle, there was significant difference between groups A and B in GFR (p = 0.000), extracellular water (p = 0.015), intracellular water (p = 0.002), plasma fluid (p= 0.016), interstitial fluid (p = 0.016), body cell mass (p = 0.024). SGA scores showed that transplant patients had normal nutritional status, but when compared with healthy individuals, there was significant difference in the fat mass, fat free mass and body cell mass as assessed by BIA.

Conclusion

Compared to patients with good graft function, patients with borderline GFR showed evidence of early nutritional depletion as picked up by BIA implying nutritional deficiency sets in with reduction in GFR (<40 ml/min) which may not be picked up by subjective global assessment but is objectively detected by BIA.