Nutrition care for renal transplant recipients: an evaluation of service delivery and outcomes

BACKGROUND: Weight gain post-renal transplantation is common. Recommendations from recent guidelines include providing structured nutrition care to target risk factors for chronic disease in the early post-transplant period.

OBJECTIVES: This study aimed to evaluate the nutrition care provided to renal transplant recipients following implementation of a dietetic model of care and to identify predictors of weight change up to one year post-transplant.

METHODS: A retrospective and observational study of one hundred and fifty-six patients that received a renal transplant from a state-wide transplant service in Australia between October 2009 and December 2010. Nutrition care provided compared with guideline recommendations within the first three months post-transplant and weight change at 12 months post-transplant, significant weight gain equating to >5% pre-transplant weight.

RESULTS: Only 35% of patients were provided with nutrition care according to guideline recommendations, were older, and had a higher BMI and diabetes. Significant weight gain was evident for half of the patients evaluated. Thirty-eight percent of healthy weight patients at transplant became overweight or obese and 23% of overweight patients at baseline became obese at 12 months. After multivariate analysis, time on dialysis was independently associated with weight change at 12 months.

CONCLUSION: Nutrition care provided did not meet guideline recommendations, highlighting difficulty in implementing evidence to practice. Significant weight gain was evident particularly in patients classified as 'healthy weight' at the time of transplant. Long-term, prospective studies are needed to determine the effectiveness of implementing nutrition care to attenuate weight gain and improve clinical outcomes.