Longitudinal Analysis of Cardiovascular Risk Factors in Active and Sedentary Kidney Transplant Recipients

Is High-Intensity Interval Training an Option for Post-Kidney Transplant Physical Rehabilitation Programmes? A Scoping Review

Purpose

To systematically and broadly review the literature to show the available information on high-intensity interval training for kidney transplant recipients as an adjunct to physical rehabilitation.

Methods

A scoping review of high-intensity interval training for post-kidney transplant patients was conducted by searching the PubMed, EMBASE (Elsevier), Scopus (Elsevier), Web of Science, and PEDro databases. Full-text records on the subject were included. Articles not published in English were excluded. The selected articles went through careful production quality analysis using the PEDro scale.

Results

The search identified 26 articles, 3 of which met the inclusion criteria. The material demonstrated satisfaction, confidence, improvement in resting heart rate, and absence of adverse effects from high-intensity interval training for kidney transplant recipients.

Conclusion

Based on this scoping review, high-intensity interval training for kidney transplant patients may be beneficial for physical and mental aspects and complement physical rehabilitation programmes, but there is a need for more studies with robust samples and long-term follow-up to confirm these benefits.

Physical activity parameters as determinants of cardiovascular disease risk in kidney transplant recipients: an accelerometer-based study

Introduction

Cardiovascular diseases are the leading cause of morbidity and mortality after kidney transplantation. Physical inactivity is an important factor for the development of cardiovascular disease (CVD) risk.

Aim

To evaluate CVD risk and its association with accelerometer-based physical activity (PA) parameters in kidney transplant recipients (KTRs).

Material and methods

This cross-sectional study included 43 KTRs. Number of steps, total energy expenditure, average sleep and lying times, average metabolic equivalent (MET), and PA duration were assessed with SenseWear Armband. CVD risk was predicted using a web-based interactive tool (HeartScore program).

Results

CVD risk was negatively correlated with number of steps, average MET and PA duration. Average MET and PA duration were significantly higher in KTRs with low CVD risk compared to KTRs with moderate CVD risk (p = 0.004 and p = 0.007, respectively). Average MET, PA duration and number of steps were significantly higher in KTRs with low CVD risk compared to KTRs with high CVD risk (p < 0.001, p < 0.001 and p = 0.009, respectively). Number of steps was higher in KTRs with moderate CVD risk compared to KTRs with high CVD risk (p = 0.010). The linear regression analysis revealed that average MET was a predictor of CVD risk, accounting for 15.9% of the variance.

Conclusions

CVD risk is associated with accelerometer-based PA parameters and average MET is a significant predictor of CVD risk after kidney transplantation in KTRs. Wearable technologies can be used to objectively measure PA parameters in order to determine CVD risk and to monitor the efficiency of PA interventions after kidney transplantation.

Assessing health literacy in transplant patients to better tailor the content of their therapeutic education: an observational study

OBJECTIVES

Evaluate health literacy in transplant patients to better tailor the content of their continuing therapeutic education.

METHODS

A 20-item questionnaire divided into five themes (sport/recreation, dietary measures, hygiene measures, recognition of the signs of graft rejection and medication management) was sent to transplant patient associations. Participants' responses (a score out of 20 points), were analysed according to demographic characteristics, transplanted organ (kidney, liver or heart), type of donor (living or deceased), participation in a therapeutic patient education (TPE) programme, management of end-stage renal disease (with or without dialysis) and the date of transplant.

RESULTS

327 individuals completed the questionnaires (mean age 63.3±12.7 years, mean time post-transplant 13.1±12.1 years). From 2 years after transplantation, the patients' score decreases significantly compared with the score obtained at hospital discharge. Patients who received TPE had significantly higher scores than patients who did not receive it, but only in the first 2 years post-transplant. The scores were different depending on the organs transplanted. Patients' knowledge varied according to the theme; the percentage of errors being higher for questions related to hygienic and dietary rules.

CONCLUSION

These findings highlight the importance of the role of the clinical pharmacist in maintaining the transplant recipient's health literacy level over time to increase graft life. We show the topics on which pharmacists must acquire solid knowledge to best meet the needs of transplant patients.

Update on Treatment of Hypertension After Renal Transplantation

PURPOSE OF REVIEW

To incorporate novel findings on pathophysiology and treatment of posttransplant hypertension.

RECENT FINDINGS

(1) The sodium retaining effects of CNIs are mediated by stimulation of the thiazide-sensitive sodium chloride co-transporter in the distal convoluted tubule and in this regard chlorthalidone was proven to be an effective antihypertensive drug in renal transplantation. (2) Local and not systemic activation of the renin-angiotensin-aldosterone system plays a crucial role in the pathogenesis of posttransplant hypertension. (3) Recent randomized controlled trials failed to prove the presumed superiority of renin-angiotensin blockers in kidney transplantation. (4) Steroid-free and mammalian target of rapamycin-based immunosuppressive drug combinations did not show favorable effects on blood pressure control. (5) In a recent report the risk of non-melanoma skin cancer was higher with thiazide diuretics. But the increased cancer risk in transplant recipients is mainly attributed to comorbidities, such as diabetes and hypertension and of course to the transplantation condition itself or the obligatory application of immunosuppression, and has little to do with the antihypertensive medication Actual recommendations about BP targets in adult renal transplant recipients are coming from a post hoc analysis of a large randomized trial with another primary endpoint. Unless convincing studies on treatment of hypertension after renal transplantation are available, the ESC/ESH Guidelines 2018 should apply for these patients.

Physical activity and renal function in the Italian kidney transplant population

Background

The well-documented benefits of physical activity (PA) are still poorly characterized in long-term kidney transplant outcome. This study analyzed the impact over a 10-year follow-up of PA on graft function in Italian kidney transplant recipients (KTRs).

Methods

Since 2002, the Italian Transplant-Information-System collected donor and recipient baseline and transplant-related parameters in KTRs. In 2015, ‘penchant for PA’ (PA ≥ 30-min, 5 times/week) was added. Stable patients aged ≥18 years at the time of first-transplantation were eligible. KTRs with at least 10-year follow-up were also analyzed. Mixed-effect regression models were used to compare eGFR changes over time in active versus non-active patients.

Results

PA information was available for 6,055 KTRs (active 51.6%, non-active 48.4%). Lower penchant for PA was found in overweight and obese patients (OR = 0.84; OR = 0.48, respectively), in those with longer dialysis vintage (OR = 0.98 every year of dialysis), and older age at transplant. Male subjects showed greater penchant for PA (OR = 1.25). A slower decline of eGFR over time was observed in active KTRs compared to non-active, and this finding was confirmed in the subgroup with at least 10-year follow-up (n = 2,060). After applying the propensity score matching to reduce confounding factors, mixed-effect regression models corroborated such better long-term trend of graft function preservation in active KTRs.

Conclusions

Penchant for PA is more frequent among male and younger KTRs. Moreover, in our group of Italian KTRs, active patients revealed higher eGFR values and preserved kidney function over time, up to 10-years of follow-up.

Occupational sedentary behavior and prediction of proteinuria in young to middle-aged adults: a retrospective cohort study

BACKGROUND

Although sedentary behavior is a risk factor of cardiometabolic diseases and mortality, little information is available about a clinical impact of occupational sedentary behavior on chronic kidney disease (CKD).

METHODS

The present retrospective cohort study included 10,212 workers of a national university in Japan who underwent annual health checkups between April 2006 and March 2013. Main exposure of interest was self-reported occupational sedentary behavior at the baseline visit. The outcome was the incidence of proteinuria defined as dipstick urinary protein of 1 + or more. The association between sedentary workers and the incidence of proteinuria was assessed using Cox proportional hazards models adjusting for clinically relevant factors, including television viewing time, the major home sedentary behavior.

RESULTS

During median 4.8 years (interquartile range 2.1-7.9) of the observational period, the incidence of proteinuria was observed in 597 (12.0%) males and 697 (13.3%) females. In males, sedentary workers were identified as a significant predictor of proteinuria (multivariable-adjusted hazard ratio of non-sedentary and sedentary workers: 1.00 [reference] and 1.35 [1.11-1.63]), along with longer television viewing time (< 30 min, 30-60 min, 1-2 h, 2-3 h, and > 3 h/day: 1.15 [0.93-1.42], 1.00 [reference], 1.24 [1.00-1.53], 1.41 [1.03-1.93], and 1.77 [1.13-2.76]), whereas not daily exercise time. In females, neither sedentary workers nor television viewing time was associated with the incidence of proteinuria.

CONCLUSIONS

In conclusion, male sedentary workers were at high risk of proteinuria. Occupational sedentary behavior may be a potentially modifiable target for the prevention of CKD.