CHAPTER THREE: GASTROINTESTINAL SYMPTOMS IN HIV-POSITIVE KIDNEY TRANSPLANT CANDIDATES AND RECIPIENTS FROM AN HIV-POSITIVE DONOR. CHAPTER SIX: ASSESSMENT OF GENERAL AND CENTRAL OBESITY IN HIV-POSITIVE TRANSPLANT CANDIDATES AND RECIPIENTS BY.
Study background
A positive HIV status was previously a contraindication for kidney transplantation (25), and an exclusion criterion for placement on transplant waiting lists (26). However, in 2008, a surgeon from South Africa (SA) pioneered the first kidney transplant involving four HIV-positive donors and recipients, with the idea that South Africa's high rate of HIV infection might offer a greater chance of finding donor kidneys, thus offering a chance. to improve prognosis in patients who would otherwise have died within months (32).
Significance of this study
Contribute significantly to current knowledge by providing insight into the physical and metabolic changes that may occur in pre- and post-kidney transplant HIV-positive patients. Provide a baseline assessment of HIV-positive kidney transplant patients that can be used for future evaluation of dietary intervention or related research.
Problem Statement
Identify patients at risk of developing clinical complications that may impact their health and quality of life. HIV-positive kidney transplant candidates who are on the waiting list for a kidney transplant from an HIV-positive donor.
Specific objectives
Based on the objectives of the study, a diagrammatic representation of the study design is shown in Figure 1.1.
Background to study sample data collection
At the time of the study, the program was still in its infancy and was in the process of establishing a formal database. The number of candidates and recipients in this program is still small, but represents 100% of the world population of this unique group.
Definition of terms
Graft survival: Refers to the period of time that the transplanted organ continues to function optimally from the time of transplantation (45). Kidney transplant: Refers to the transfer of a human kidney from a donor to a recipient for the purpose of restoring kidney function (46).
Abbreviations
Health-related quality of life: Refers to multiple dimensions of health that include physical, mental, emotional, and social functioning (47). PF: Physical functioning PEM: Protein energy malnutrition PEW: Protein energy wasting PI: Protease inhibitor PTH: Parathyroid hormone QOL: Quality of life.
Thesis Structure
Accurate reporting of body composition requires measurement verification, which can be described as a form of quality assurance for the chosen method shown in this chapter. Chapter seven is a longitudinal study using a mixed-methods approach to determine participants' health-related quality of life and the association with musculature.
Guidelines for the management of chronic kidney disease in HIV-infected patients: recommendations from the HIV Medicine Association of the Infectious Diseases Society of America. Kidney transplantation in HIV-infected patients: experience in a tertiary hospital in Spain and literature review.
Transplant candidates – pre-transplant protein energy wasting (PEW)
- Pathophysiology of PEW
- Inadequate nutrient intake, utilisation and increased losses
- The consequences of PEW as it relates to clinical outcomes
- Pre-transplant BMI on clinical outcomes
Because PEW is independently associated with estimated glomerular filtration rate (eGFR), its prevalence increases in proportion to progression of chronic kidney disease ( 15 ). Although some studies, such as that of Marcén et al., showed that pretransplant BMI was not associated with overall graft failure or 2-year patient survival (60).
Kidney transplant recipients – post transplant obesity and metabolic disorders
- Weight and body composition changes
- Dyslipidaemia following renal transplantation
- Hyperglycaemia and post-transplant diabetes
- Anthropometric evaluation of body composition
- Biochemical parameters of selected nutritional status outcomes
- Clinical evaluation of gastrointestinal symptoms (GIS)
- Evaluation of nutrient intake
- Evaluation of bone mineral density
Abdominal obesity may be prevalent before transplantation, as HD patients have presented with excess visceral fat (VAT) and possibly associated with changes in lipid levels (87). The presence of the metabolic syndrome predisposes to diabetes, contributes to early graft loss, and substantially increases the risk of a cardiovascular event (88). It is one of the most widely validated instruments used in the dialysis population (123) and, together with the GIQLI, shows very good discriminatory ability in kidney transplant recipients (125).
Health-related quality of life
- The concept health related quality of life
- HRQOL of transplant candidates and recipients
- Factors affecting HRQOL
- The effect of nutritional status on HRQOL in HIV and kidney transplantation
Quality of life (QOL) and HRQOL are distinct concepts, although they have been used interchangeably, perhaps because a clear definition of each remains elusive (131). Disease-specific measures have the advantage of being sensitive to health changes during the course of the disease.
Conclusion
Participants
Participants were recruited through the Renal Transplant Program for HIV-positive patients at Groote Schuur Hospital in Cape Town to participate in this longitudinal observational study. From the very beginning, they were therefore categorized as:. i) HIV-positive kidney transplant recipients who received a kidney from an HIV-positive donor and (ii) HIV-positive transplant candidates on the waiting list to receive an HIV-positive donor kidney.
Socio-demographic and clinical characteristics
Participants were recruited based on whether they were transplant recipients or awaiting a transplant and therefore managed with dialysis. Patients were not eligible for participation if they were seriously ill, uncontactable, uncooperative, or missed multiple interview appointments (usually more than two without reason).
Anthropometry
Potential participants were contacted by telephone or at their respective clinics and invited to participate. A total of 76 patients agreed to participate according to the purpose of the study and the practical implications were explained to them.
Statistical analysis
The combined severity of the five subscales is presented as a global average score and an average score per item. subscale.
Patient characteristics
Gastrointestinal symptoms
Overall, 88.9% of dialysis participants reported at least one GIS at baseline and 81.5% at six-month follow-up (Figure 3.1). Indigestion was the most severe GIS with the highest median GSRS score of 2.33 at baseline and 1.33 at six months (Table 3.3).
Transplant candidates
The occurrence of at least one GIS (GSRS > 1) in the total group, at baseline and at 6 months was high. In the general population, women experience more dyspeptic and irritable bowel syndrome symptoms due to gender-specific psychosocial factors, hormonal activity, and anatomical and functional changes in pain transmission pathways that affect sensitivity (42,43). .
Transplant recipients
In contrast, the frequency of GIS in the current study decreased by 19.0% to 76.2%, for reasons that are unclear. Significant associations between GSRS constipation scores and WC were identified in the transplant group at baseline.
Gastrointestinal symptoms and HIV
The data confirm the high prevalence of GIS in both treatment groups, although they are similar to those documented for HIV-uninfected dialysis and transplant recipients. Indigestion was the predominant and severe GIS in the entire group at both time points, while those on dialysis had a higher incidence of constipation at six-month follow-up.
Increased prevalence of gastrointestinal symptoms associated with reduced quality of life in kidney transplant recipients. Gastrointestinal symptoms in patients with end-stage renal disease undergoing treatment with hemodialysis or peritoneal dialysis.
Methods
- Participants
- Socio-demographic and clinical characteristics
- Bone densitometry measurements
- Vitamin D measurement
- Dietary intake
- Statistics
- Participant characteristics
- Nutritional status parameters
In the present study, osteoporosis by skeletal region among transplant recipients was 15.0% (LS) and 5.0% (TH). Given the association with BMD, this may be one of many contributors to the higher incidence of osteoporosis in the transplant group.
Obesity and low muscle mass are associated with adverse outcomes in kidney transplant candidates and recipients. Objective: To correlate anthropometric measures with dual-energy X-ray absorptiometry (DEXA) as a reference standard in kidney transplant candidates and recipients.
Methods
- Participants
- Socio-demographic and clinical information
- Anthropometric measurements
- Statistics
Reference values for lean mass were lean mass (LM), lean mass index (LMI) and appendicular mass index (AMI). ALMI is calculated from the lean mass of arms and legs in kg divided by H (m2).
Results
Participant characteristics
The independent samples t test was used to determine the differences between the clinical and nutritional variables of the transplant candidates and recipients. Similarly, all DEXA measures of adipose tissue were higher in transplant candidates compared to transplant recipients.
A comparative evaluation of waist circumference, waist-hip ratio, and body mass index as indicators of cardiovascular risk factors. An increase in body mass index (BMI) corresponds to a greater risk of certain cancers, cardiovascular disease (CVD), type 2 diabetes mellitus, and higher mortality rates (1).
Methods .1 Participants
Socio-demographic and clinical information
Diet is an important modifiable component of weight gain (7) and has been previously studied in transplant recipients but not in the HIV-infected population. Therefore the objectives in this study population were 1) to determine the participants' weight, BMI and WC at baseline and to observe changes in these anthropometric indicators after six months, 2) to classify BMI and WC to determine the prevalence of obesity and MetS, and 3) to determine the relationship between the macronutrient composition of the diet, weight and WC. Dietitians were recruited to take anthropometric measurements because of their training and experience in this field.
Biochemical metabolic parameters
WC cut-offs used were WC ≥ 88 cm for women and ≥ 102 cm for men, indicating a significantly increased risk of metabolic complications (25). It should be noted that the WC used in this definition of MetS differs from the general WC thresholds (paragraph 6.2.3).
Dietary intake
The presence of MetS was based on a recent consensus definition of MetS that includes the International Diabetes Federation (IDF), American Heart Association (AHA), and National Heart, Lung and Blood Institute (NHLBI) MetS definitions ( 13 ). The Paired Samples T-test was used to determine whether weight changes between the two assessment points were significantly different.
Results
Participant baseline characteristics
Chi-square test of independence or Fisher's exact test was used to test for differences in categorical variables between the two treatment groups. There were no other significant differences in demographic and clinical characteristics between the two groups.
Clinical and nutritional characteristics of transplant candidates
Average daily energy intake of transplant candidates was similar at baseline and six months in kJ/day and.
Change in weight from baseline to six months
The prevalence of the metabolic syndrome
Clinical and nutritional characteristics of transplant recipients
The average daily energy intake of transplant recipients was slightly higher than transplant candidates with baseline and six-month values kj/day and kj/day, respectively. Significantly more transplant recipients had normal BMI at baseline, while transplant candidates were obese, Fisher's exact = 9.004, p=0.033.
Discussion
- Transplant candidates
- Transplant recipients
The proportion of recipients with weight gain was not dissimilar to that seen in kidney transplant recipients in the general population. Furthermore, in the transplant population, the incidence of MetS appears to increase over time (58).
- Participants
- Socio-demographic and clinical information
- Health related quality of life
- Biochemistry
- Data analysis Quantitative data
- Participant characteristics
- Participant nutritional characteristics
- Health related quality of life – Quantitative results
- Health related quality of life – Qualitative results
Intensive nutritional counseling prevents weight gain in kidney transplant recipients with long-term graft survival in Estonia [version 1; judges: 2 approved with reservations]. A better HRQOL has been reported in kidney transplant recipients compared to transplant candidates on dialysis.
Discussion
- Transplant candidates
- Socio-demographic factors associated with HRQOL in transplant candidates and recipients
- Comorbidity and HRQOL
- Nutritional parameters associated with HRQOL
In the present study, the majority of transplant recipients did not show symptoms indicative of depression (51). Lower income corresponds to lower QOL in the general population (63), as do financial and employment concerns among non-HIV HD and PD patients in Cape Town (55).
Assessment of physical performance and quality of life in kidney transplant patients: a cross-sectional study. Health-related quality of life in hemodialysis and peritoneal dialysis patients: a meta-analysis of Iranian studies.
Objectives and methods
Fortunately, nutrition is a modifiable factor, and improvements in nutritional status can contribute to meaningful changes in health and quality of life. Therefore, this research aimed to explore the nutritional status and quality of life of HIV-positive kidney transplant candidates and recipients from HIV-positive donors by conducting assessments to determine numerous measures of nutritional health at baseline and at six-month follow-up.
Summary of findings and implications for practice
In addition to education, it is suggested that, like BMI, waist circumference should be a mandatory measurement. It is also recognized that the intention was to obtain three non-consecutive 24-hour recalls.
Recommendations for future research
- Logistical and design considerations
