Efeitos da terapia nutricional sobre a função renal, composição corporal e qualidade de vida de indivíduos submetidos ao transplante renal

Abstract

Proteinuria, a common clinical condition after kidney transplantation (KTx), has multifactorial causes. There is evidence that high dietary protein intake may influence renal function outcomes in late posttransplant. Therefore, there is an indication for nutritional therapy with control of protein intake, but there are gaps on the real impact of interventions on renal function parameters and other posttransplant aspects. The aim of this study was to evaluate the effect of an individualized nutritional intervention in the late posttransplant on renal function, body composition and quality of life of KTx recipients at a University Hospital in Natal/RN. This is a clinical trial, conducted with 20 patients, randomized into a case group (n=10) – with nutritional intervention consisting of an eating plan and individualized nutritional guidelines (1,0 g of protein/Kg of weight/day) after 60 days of KTx, and control group (n=10) – with nutritional guidelines for posttransplant offered by the hospital. The groups were followed up in the periods of immediate posttransplant (T0), 3 (T3), 6 (T6) and 9 (T9) months after KTx, being evaluated for renal function (urea concentrations, serum creatinine and albumin ratio:creatinine – ACR), lipid and glycemic profile, dietary assessment (3-day dietary record), anthropometric measurements (BMI and waist circumference) and body composition (DXA), in addition to the assessment of quality of life (SF-36), level of physical activity (IPAQ) and screening for mental disorders (SRQ-20). The reduction in ACR was considered as the primary outcome. The results showed a 30% reduction in the mean values of the ACR, for the case group at T6, with no significant difference between groups (p=0,886). There was a significantly lower intake of energy in Kcal (p=0,004) and proteins in g/Kg/weight (p=0,016), for the case group, in T6, when compared to the control. There was an improvement in the dyslipidemia condition, with mean values of TC, LDL-c and TG within the cutoff points, for the case group, still at T6, however without significant differences with the control (p=0,496). The glycemic levels of the case group did not show a reduction, as perceived for the control, in T6, but remained stable and with a tendency to decrease in T9 (p=0,690). Body weight was maintained for patients in the case group, but there was no reduction in the percentage of body fat and an increase in lean mass, as observed for the control group, at T6 (p=0,964 and p=0,761, respectively). There was a negative correlation between protein intake and fat mass at T0 (r=-0,523 / p=0,018) and T6 (r=-0,636 / p=0,048) for the case group. As for quality of life, there was a significant improvement in the score of the ‘vitality’ domain of the emotional component (p=0,022), for the case group, at T6. In conclusion, the individualized nutritional intervention favored the control of energy and protein intake in the late posttransplant, and this may be important for reducing the risk of proteinuria, improving quality of life and maintaining body weight if a reduction in muscle mass is observed.