Program Benefits Obese CKD Patients

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Protocol credited with helping patients lose weight and become eligible for a renal transplant.

 

BARCELONA—British researchers have developed a weight-management program that has enabled obese CKD patients to lose a significant amount of weight and improve their functional ability and exercise capacity overall.

 

At one year, those who completed the program had maintained their initial weight loss, allowing almost one third of the group to become eligible for kidney transplantation. Findings were presented here at the 44th Congress of the European Renal Association-European Dialysis and Transplant Association.

 

The researchers assigned 39 patients with a mean BMI of 35.7 kg/m2 (either on or not on dialysis) to their weight management program and another 20 weight-matched CKD controls to an observation group. Treatment consisted of individualized, low-fat, reduced, calorie, renal-specific diets and planned exercise regimens in addition to 120 mg three times daily.

 

During the first six months, patients attended between three and seven 30-minute appointments with a dietitian and a physiotherapist during which they were counseled on individualized eating and exercise plans, goal setting, cognitive behavioral therapy, and dietary education. Between months seven and 12, patients continued to follow the same weight management program but came to the clinic only for monitoring at nine and 12 months.

 

At six months, mean body weight in the weight management group had dropped by 6.6% from baseline compared with no change in the control group, a significant difference between the groups. At 12 months, mean body weight was 7.3% lower than baseline in the weight management group compared with no change in the control group.

 

In addition, both systolic and diastolic BP in the weight management group were significantly lower than baseline at six months; systolic BP and diastolic BP decreased by 12 and 4 mm Hg, respectively. No significant changes in either BP measurement were ob-served in the control group at six or 12 months.

 

In a subgroup of 11 patients in the weight management group who had full waist circumference data available, waist circumference decreased significantly by 12.1 cm after six months, a reduction that was maintained at 12 months. In the 10 patients who completed exercise tests, all measures of functional capacity increased progressively and significantly throughout the 12 months.

 

Twenty-six patients in the weight management group were eligible for renal transplantation except for being overweight. Eight of these patients reached a predetermined weight loss goal set by a transplant surgeon and thus became eligible to be placed on a transplant waiting list. Two went on to receive a transplant. “The [weight management] program was designed as a package that could be used elsewhere, as long as the setting is multidisciplinary,” commented investigator Helen MacLaughlin, clinical specialist renal dietitian, King's CollegeHospital, London, UK.

 

Indeed, several other hospitals in the UK have adopted the same approach, she said. “But maintaining increased exercise and continuing with both the medication and a low-fat diet also play a major role in weight maintenance,” she said, adding that the behavioral strategies learned during the first six months of consultation in the program may have helped patients maintain weight loss over the longer term. A desire to get onto a transplant list also was a motivating factor.

 

A large retrospective analysis of data from the Netherlands Organ Transplantation Registry published last year in Transplant International (2006;19:901-907) showed that early graft loss in obese transplant recipients oc-curred at a rate of 9.5% compared with 5.5% in non-obese patients.

 

According to researchers, rates of graft survival, death-censored graft survival, and one- and five-year mortality rates were also significantly poorer among obese transplant recipients compared with their non-obese counterparts.

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