Lack of protein negatively impacts skeletal muscle mass recovery after kidney transplant
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Protein intake positively correlated with recovery of skeletal muscle mass in kidney transplant recipients, according to a study in Clinical Nutrition.
Further, for those experiencing skeletal muscle mass loss after transplantation, a recommendation of protein consumption of more than 0.72 g/kg of ideal body weight per day may help in recovering it, according to researchers.
“Until recently, it has been generally believed that excess protein intake leads to the deterioration of renal function for patients with chronic kidney disease, and that renal function should be protected by restricting protein,” Akihiro Kosoku, MD, PhD, from the department of urology at Osaka Metropolitan University Graduate School of Medicine, in Osaka, Japan, told Healio. “Recently however, it has become clear that sarcopenia is associated with a lowering of life expectancy, and the adverse effects of severe protein restriction have been mentioned in the context of sarcopenia control.”
“Our study suggests that for certain cases, such as kidney transplant recipients with sarcopenia, guidance for adequate protein intake should be given above the protein intake recommended in the Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines,” Kosoku added.
Skeletal muscle mass, protein
In a prospective cohort study, Kosoku and colleagues studied 64 kidney transplant recipients and 17 living kidney donors at Osaka City University Hospital in Japan to observe the relationship between changes in skeletal muscle mass and protein intake.
Through bioelectrical impedance analysis, researchers took measurements of skeletal muscle mass index (SMI) before kidney transplantation and at 1 month and 12 months after transplantation. Researchers also determined protein intake at 12 months after transplantation through a 24-hour urine collection.
Additionally, a multivariable regression analysis adjusted for covariates was conducted.
Findings
Before kidney transplantation, the researchers observed a median SMI of 7.26 kg/m2 for transplant recipients. At 1 month after transplantation, the SMI fell to 7.01 kg/m2; however, it increased to 7.55 kg/m2 12 months after transplantation.
For living kidney donors, the median SMI taken before transplantation was 6.24 kg/m2. At both 1 month and 12 months after transplantation, researchers found SMI increased to 6.4 kg/m2 and 6.95 kg/m2, respectively.
After adjusting for covariates, a positive association between SMI changes within a 1-year period after transplantation and protein intake was found, according to researchers.
Additionally, though a multivariable non-linear regression model, researchers predicted that 0.72 g/kg of ideal body weight per day was the amount of protein consumed by kidney transplant recipients.
“The KDOQI guidelines recommend protein intake of 0.55 g/kg to 0.6 g/kg per day for non-dialysis CKD patients (stages 3-5) without diabetes, and 0.6 g/kg to 0.8 g/kg per day for those with diabetes,” Kosoku told Healio. “In our study, kidney transplant recipients with protein intake less than 0.72 g/kg (of ideal body weight) per day had decreased skeletal muscle mass; nutritional guidance as per the KDOQI guidelines may result in decreased skeletal muscle mass and sarcopenia in many kidney transplant recipients.”
For future studies, Kosoku said researchers should evaluate the ideal protein intake amount to aid kidney transplant recipients.
“This time our study did not examine the adverse effects of high protein intake on renal function,” Kosoku said. “Further studies are needed to improve the life expectancy of kidney transplant recipients, including identifying the optimal level of protein intake, to prevent sarcopenia while also preventing the decline in renal function.”
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