Kidney Week

Abstract: SA-PO794

Low Protein Intake Is Associated with Severe Fatigue in Stable Outpatient Renal Transplant Recipients

Session Information

• Health Maintenance, Nutrition, Metabolism - II
  November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Health Maintenance, Nutrition, and Metabolism

• 1300 Health Maintenance, Nutrition, and Metabolism

Authors

• Gomes Neto, Antonio Wouter, University of Groningen, University Medical Center Groningen, Groningen, Netherlands

Antonio Wouter Gomes Neto,

• Geelink, Marit, University of Groningen, University Medical Center Groningen, Groningen, Netherlands

Marit Geelink,

• Douwes, Rianne M., University of Groningen, University Medical Center Groningen, Groningen, Netherlands

Rianne M. Douwes,

• Van vliet, Iris, University of Groningen, University Medical Center Groningen, Groningen, Netherlands

Iris Van vliet,

• Post, Adrian, University of Groningen, University Medical Center Groningen, Groningen, Netherlands

Adrian Post,

• Rosmalen, Judith, University of Groningen, University Medical Center Groningen, Groningen, Netherlands

Judith Rosmalen,

• Joustra, Monica L., University of Groningen, University Medical Center Groningen, Groningen, Netherlands

Monica L. Joustra,

• Knoop, Hans, University of Amsterdam, Academic Medical Center, Amsterdam, Netherlands

Hans Knoop,

• Berger, Stefan P., University of Groningen, University Medical Center Groningen, Groningen, Netherlands

Stefan P. Berger,

• Navis, Gerjan, University of Groningen, University Medical Center Groningen, Groningen, Netherlands

Gerjan Navis,

• Bakker, Stephan J.L., University of Groningen, University Medical Center Groningen, Groningen, Netherlands

Stephan J.L. Bakker,

Background

Severe fatigue is a frequent complaint in renal transplant recipients (RTR) that is often accompanied by functional impairment and poor quality of life. Low protein intake may lead to protein-energy malnutrition and thereby contribute to fatigue in RTR. We aimed to (1) compare the prevalence of severe fatigue between RTR and healthy controls, (2) investigate impact of severe fatigue on quality of life in RTR, and (3) investigate the association of protein intake with severe fatigue in RTR.

Methods

We included 601 stable RTR with a functioning graft >1 year and 237 prospective kidney donors from the TransplantLines Study. Overall fatigue was assessed using the Checklist Individual Strength (CIS) Questionnaire. A CIS-score >76 is commonly considered to indicate severe fatigue and was used as cut-off in this study. Quality of Life (QoL) was assessed with the RAND-36 Questionnaire. The Maroni formula was used to calculate protein intake from 24-hr urinary urea excretion. Chi-Square was used to test differences in prevalence of severe fatigue in RTR and donors. Mann-Whitney U was used to test differences in QoL of RTR with and without severe fatigue. Logistic regression was used to analyze the association between protein intake and presence of severe fatigue.

Results

RTR were 55 ± 13 years old, 347 (58%) were male and mean eGFR was 50 ± 18 ml/min/1.73m². Thirty-three percent of RTR were severely fatigued compared to 6% of kidney donors (P<0.001). QoL was significantly lower in RTR with compared to RTR without severe fatigue (median QoL-score 40 [30-60] vs 60 [50-75], P<0.001). Mean protein intake in RTR was 1.0 ± 0.3 g per kg bodyweight per day. Protein intake was inversely associated with severe fatigue in RTR (OR 0.17; 95%CI 0.07-0.40 per g/kg/d, P<0.001). This association remained materially unchanged after adjustment for potential confounders, including age, sex, eGFR, BMI, and anaemia (OR 0.20; 95%CI 0.08-0.51 per g/kg/d, P=0.001).

Conclusion

Severe fatigue is highly prevalent in RTR and a determinant of poor quality of life. Low protein intake is associated with higher risk of severe fatigue in RTR, independent of potential confounders, including age, sex, eGFR, BMI, and anaemia.