Nutrition and malnutrition in kidney transplant recipients

Kidney transplantation is the preferred treatment for end-stage kidney disease, offering better quality of life and life-expectancy compared to dialysis. Nevertheless, life expectancy remains considerably lower compared to the general population. Nutrition is increasingly being recognized as an actionable risk-factor for the prevention and management of chronic diseases and we explored whether nutritional factors could serve as potentially modifiable risk-factors after kidney transplantation. We investigated the associations between dietary intake of marine-derived omega-3 fatty acids, fruit and vegetable intake, adherence to healthy dietary patterns such as the DASH- and Mediterranean diet and nutritional status with long-term outcomes after kidney transplantation. A higher intake of marine-derived omega-3 fatty acids and high vegetable intake were associated with lower mortality risk after kidney transplantation. Moreover, higher vegetable consumption was associated with a lower risk for development of diabetes after kidney transplantation, notwithstanding the use of diabetogenic medication, i.e steroids. Also, adherence to healthy dietary patterns such as the DASH- and Mediterranean diet was beneficial, as apparent from a lower risk for kidney function decline and graft failure after transplantation. Moreover, 1 out of 10 outpatient kidney transplant recipients were malnourished and that quality of life and life-expectancy was significantly worse in these patients, further underlining the importance of nutrition after kidney transplantation. In conclusion, evaluation of nutrition data revealed multiple targets for intervention, some hitherto unexpected, that can improve outcome in kidney transplant recipients. Monitoring of nutrition and nutritional status should become part of routine care after kidney transplantation, to guide better nutrition counseling, and eventually, better outcomes