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Program helps kidney transplant recipients avoid common weight gain, shows additional potential

Monday, August 20, 2018

LAWRENCE — When patients receive a kidney transplant, it is common for them to gain weight in the immediate aftermath. Gains of more than 10 percent of a person’s body weight can lead to a host of problems such as cardiovascular disease, new-onset diabetes, metabolic syndrome and graft failure.

Although weight gain after transplant can potentially be prevented with dietary changes and increased physical activity, these can be difficult to practice in a clinical setting where the transplant team has to focus on multiple issues. University of Kansas researchers have tested a program that helps kidney transplant recipients improve their diet, increase physical activity and prevent weight gain, all without leaving their home.

The researchers held weekly online meetings with participants for three months to deliver tailored nutrition information from a registered dietitian and remote delivery of activity led by an adaptive physical activity expert, then followed up to check progress at six months. They found the program effective at helping participants control weight gain and improve physical activity while proving immensely popular and showing great potential for a multitude of other health programs.

Kidney transplant patients frequently gain weight after receiving their new kidney for a number of reasons, including a less restrictive diet than required during dialysis, improved appetite, immunosuppressant medications and sedentary lifestyles.

“Obesity after transplantation puts patients at a higher risk of cardiovascular disease and graft failure, among other problems,” said Cheryl Gibson, professor of internal medicine at KU Medical Center. “If they are placed on the transplant waiting list for re-transplantation, the chances of them getting another kidney are often low due to obesity. In addition, a repeat transplant puts patients at a higher risk of rejection.”

Gibson conducted the study with KU colleagues Dr. Aditi Gupta, a transplant nephrologist; Rebecca Mount, study coordinator and registered dietitian, and Leon Greene, associate professor of health, sport & exercise science. They recently presented their results at the American Society of Nutrition Conference in Boston.

Ten kidney transplant recipients took part in the program. Those in the intervention group received weekly sessions online led by Mount that focused on increasing fruit, vegetable and whole grain intake while replacing sugary beverage consumption with water. Sessions covered topics such as goal setting, self-monitoring, portion control, meal planning and shopping, cooking skills and how to eat healthy away from home. Greene led the physical activity sessions intended to get participants moving, increase their steps throughout the day and make activity part of their daily lives.

“Activities that were used in this study consisted of movement that could be done in the home and without the use of equipment such as abdominal curls, pushups, jogging in place, running in place, vertical jumps, stretching exercises, movement to music and some basic yoga exercises,” Greene said. “The objective of each 30-minute workout was to have the participants in continuous movement. The lessons were progressive in nature with the emphasis being on personal safety, fun and enjoyment.”

The participants received kidney transplants for different reasons. This is important as a number of conditions can necessitate transplants and the researchers wanted this intervention to be generalizable across the kidney transplant population. The University of Kansas Health System Center for Transplants performs about 130 of such procedures every year. According to the U.S. Department of Health and Human Services, there were 19,849 kidney transplants performed in the country in 2017. Post-transplant weight gain is a common problem across the country, and the information from this study can markedly improve the outcomes of many transplant recipients.

The program showed progress in a number of areas and proved to be very popular with participants. Ninety percent of participants were retained through the entire six months, and 100 percent said they would recommend it to others. There was a statistically significant increase in physical activity and a significant improvement in fruit and vegetable consumption.

The researchers hope to refine the program to improve weight gain prevention, but they learned a great deal about what works in a telemedicine program. Among the program’s strengths was allowing people to take part in a health-related program without joining a gym or needing to travel to a health care center. The online delivery allows participants from anywhere in the country to take part.

“We were very happy the participants liked the program,” Gibson said. “They reported feeling isolated during dialysis and recovery and loved being able to talk to people in the same situation they were in and said they wanted to participate in the program longer.”

The researchers are seeking National Institutes of Health funding to refine and expand the program for kidney transplant recipients and ultimately for others. The potential is unlimited, especially if telemedicine is allowed to be billed to insurance. There is nothing in the published research literature like the telemedicine program for transplant recipients right now, the researchers said.

“It really opened our eyes about what works in a telemedicine delivery program,” Gibson said. “We think this is a really good fit for kidney transplant patients, and our hope is this kind of technology would be used across all kinds of chronic health conditions.”

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