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Abstract: TH-PO177

To Study the Effect of Variable Protein Intake on Nitrogen Balance in Renal Transplant Recipients with Underlying Graft Dysfunction

Session Information

Category: Transplantation

  • 1802 Transplantation: Clinical

Authors

  • Sirsat, Rasika A., P. D. Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
  • Shah, Neha, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
  • Almeida, Alan F., P. D. Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
  • Kothari, J., P. D. Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
  • Trivedi, Mayuri, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, Maharashtra, India
Background

It is essential to determine the optimum nutrition (protein intake) in renal transplant recipients on steroids with renal dysfunction to maintain a neutral nitrogen balance. It was our aim to study the effect of variable protein intake [i.e.higher (1.2g/kg/d) and lower (0.8g/kg/d) protein intake] on nitrogen balance, body composition, glomerular filtration rate and proteinuria in renal transplant recipients with low eGFR (15–44 ml/min/1.73m2).

Methods

This prospective, open-labelled, randomized, cross-over, interventional study enrolled 35 patients who were ≥ 4 months post-transplant and who had an eGFR between 15 - 44 ml/min/1.73m2. Thirty-two patients completed the study. The subjects were randomised to either Group 1 [Diet: proteins (1.2 g/kg/day) and 35 kcal/kg/day] or Group 2 [Diet: proteins (0.8 g/kg/day with 50% first class proteins) and 35 kcal/kg/day] for one month. The subjects crossed over to the other diet for the second month. The body composition analysis, sr. creatinine, blood urea nitrogen, sr. protein, sr. albumin, 24 hours proteinuria, GFR measurement (24 hours creatinine clearance), three day diet recall and nitrogen balance estimation were performed at baseline and at the end of the first and second months. Statistical analysis was performed using SPSS version 21.

Results

The three day diet recall showed that the daily protein and energy consumption was 1.2 g/kg and 36.47 kcal/kg with the higher protein diet and 0.94 g/kg protein with 31.94 kcal/kg with the lower protein diet. The nitrogen balance was positive with both the diets, +3.61 g/d with the higher protein diet (p=0.0002) and +1.66 g/d with the lower protein diet. The waist hip ratio showed a significant decrease on the higher protein diet (p=0.011) and increase on the lower protein diet (p=0.011). There was significant gain in muscle mass (0.70 kg gain; p=0.0317) with the higher protein diet. Significant increase was noted in blood urea nitrogen (p=0.0048) and GFR (p=0.0114) with the higher protein diet. 24 hours urinary protein excretion increased significantly after consuming the higher protein diet (320mg/d, p=0.010).

Conclusion

Renal transplant recipients remained in positive nitrogen balance with both diets. Muscle mass and proteinuria increased significantly with the higher protein diet.

Funding

  • Private Foundation Support