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      Nutritional Considerations in Renal Transplant Patients

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          In renal transplant patients, weight gain generally increases after renal transplantation, which will be influenced by improved appetite and a reversal of the uremic state. However, at least in the early posttransplant period, the increase in body weight is mainly due to an increase in body fat mass. This phenomenon may be partly due to relatively high doses of steroids in the early period after renal transplantation, possibly mediated by their inhibiting effect on lipid peroxidation, but also appears to be related to physical inactivity. The increase in body fat mass may contribute to posttransplant hyperlipidemia, which is improved but not completely normalized by dietary intervention. Current dietary recommendations in stable renal transplant patients do not generally differ from those of the general population, although intense dietary counselling may be indicated in patients with excessive posttransplant weight gain. The effect of supervised exercise training on body composition is currently under investigation.

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          Plasma Immunoreactive Leptin and Neuropeptide Y Levels in Kidney Transplant Patients

          Leptin and neuropeptide Y (NPY) seem to play an important role in food intake and energy expenditure. Leptin is secreted by adipose tissue in proportion fo fat stores and is presumed to be an important anorectic hormone. NPY is produced by the hypothalamus, and in contrast to leptin, is one of the most potent appetite stimulants yet demonstrated. On the other hand, in most patients increased appetite is present after successful kidney transplantation. Finally, a stimulatory effect of glucocorticoids on leptin secretion was reported. The present study aimed to assess the relationship between plasma leptin and NPY levels and body mass index (BMI) in haemodialyzed patients (HDP) with chronic renal failure and in kidney transplant patients (KTP). In both groups, BMI was of the same magnitude as in healthy controls. Despite the presence of a normal BMI, leptin levels in KTP (25.2 ± 3.6 ng/ml) and in HDP with chronic renal failure (25.3 ± 4.2 ng/ml) were higher than in controls (11.7 ± 1.8 ng/ml). The mean plasma NPY level in KTP (168.0 ± 10.3 pg/ml) was significantly higher (p < 0.01) than in controls (70.7 ± 5.9 pg/ml) and in HDP (77.0 ± 5.7 pg/ml). In all examined groups, a significant positive correlation was found between leptinaemia and BMI. Conclusions: (1) KTP are characterized by significantly elevated leptinaemia in spite of a normal BMI. In KTP this increased leptinaemia does not seem to be dependent only upon the fat mass and the kind and dosis of immunosuppressive therapy. (2) Similarly to healthy subjects, female KTP and HDP show markedly higher leptinaemia than males. (3) In contrast to healthy subjects and HDP, KTP are characterized by significantly elevated plasma NPY levels.

            Author and article information

            Blood Purif
            Blood Purification
            S. Karger AG
            30 January 2002
            : 20
            : 2
            : 139-144
            Department of Internal Medicine, University Hospital Maastricht, The Netherlands
            46999 Blood Purif 2002;20:139–144
            © 2002 S. Karger AG, Basel

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