title: Co-morbidity and kidney graft failure-two main causes of malnutrition in kidney transplant patients.
abstract: BACKGROUND
  Malnutrition is very frequent in chronic renal failure but, after successful kidney transplantation, body weight gain is common and is widely investigated, while malnutrition after transplantation is underestimated. In the present study, the prevalence of malnutrition in kidney transplant patients and the factors which might contribute to its development are analysed.
  
  
  METHODS
  In a population of 452 kidney transplant patients followed-up regularly at our department, body mass index (BMI) was determined. Out of this population, 47 patients (18 females, aged 13-54 years, post-transplantation period 6-180 months) were randomly selected for more detailed examination of their nutritional status using anthropometry (body weight, the mid-arm muscle circumference, skinfold thickness, BMI) as well as biochemical parameters (serum protein, albumin, cholesterol, red blood cell count). Co-morbidity of the selected patients was assessed using the Index of Coexistent Diseases.
  
  
  RESULTS
  Among 452 kidney transplant patients, 15% had a BMI of <21 kg/m(2), 45% had a BMI of 21-25 kg/m(2), and 40% had a BMI >25 kg/m(2). After more accurate assessment of nutritional status of the selected 47 patients, a comparison between those who were malnourished (11 patients) and those who were well nourished (20 patients) was made. No significant difference was found in age at transplantation, pre-transplantation time on dialysis, donor origin, early post-transplant course, immunosuppressive therapy, number of rejection episodes or post-transplant period between these two groups. However, malnutrition appeared significantly more frequently in females, and malnourished patients had significantly higher serum creatinine levels. Co-morbidity conditions, assessed by the Index of Disease Severity and Index of Physical Impairment combined peak scores resulting in the final Index of Coexistent Disease, were more frequent and more severe in malnourished patients as compared with well-nourished patients.
  
  
  CONCLUSIONS
  In a population of kidney transplant patients regularly followed-up at our clinic, 15% had malnutrition. Malnutrition is more frequent in females, but kidney graft failure and co-morbidity had a significant role in its development.
authors.affiliation: Clinic of Nephrology, Institute of Urology and Nephrology, Clinical Center of Serbia, Beograd, Yugoslavia. mamatata@eunet.yu
authors.forename: Ljubica
authors.initials: L
authors.lastname: Djukanović
authors.forename: Visnja
authors.initials: V
authors.lastname: Lezaić
authors.forename: Radmila
authors.initials: R
authors.lastname: Blagojević
authors.forename: Dragana
authors.initials: D
authors.lastname: Radivojević
authors.forename: Milan
authors.initials: M
authors.lastname: Stosović
authors.forename: Natasa
authors.initials: N
authors.lastname: Jovanović
authors.forename: Stojanka
authors.initials: S
authors.lastname: Ristić
authors.forename: Sanja
authors.initials: S
authors.lastname: Simić-Ogrizović
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D001774:Blood Chemical Analysis; D015992:Body Mass Index; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D044342:Malnutrition / Q000453:epidemiology* / Q000209:etiology*; D008875:Middle Aged; D009751:Nutritional Requirements; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017678:Sex Distribution