A prospective trial of diet and exercise to improve glucose metabolism and cardiovascular risk for de novo kidney transplant recipients treated with tacrolimus-based immunosuppression.

Aim: To conduct a pilot trial of diet and exercise to determine feasibility and examine outcomes. Background(s): New Onset Diabetes After Transplantation (NODAT) is common and is predictive of increased mortality. We hypothesised that progressive resistance training (PRT) coupled with dietary advice may improve body composition, decrease insulin resistance and reduce NODAT prevalence. Method(s): Kidney recipients were enrolled 6-8 weeks after transplantation (n = 56) across 4 sites. All received basiliximab, tacrolimus, mycophenolate and steroids. All received dietary assessment/advice plus supervised instruction on PRT, followed by unsupervised PRT for 6 months. Assessments included 3-day food diary, anthropometrics, body composition (DEXA), strength testing, OGTT, kidney function, SF-36. Result(s): Fifty-six patients were enrolled; 9 discontinued prematurely (back pain (2), depression (2), lymphoma (1), non-compliance (1), withdrawal of consent (3)). Intention to treat analysis comparing baseline to study-end demonstrated trends toward less diabetes (24.5% v 11.4%) andinsulin resistance (93.5% v 82.6%). HbA1c (5.6 +/- 0.6 v 5.7 +/- 0.6) was unchanged. Despite reductions in measured caloric intake (8791 +/- 2771 KJ v 7691 +/- 2561) and increased physical activity, BMI (24.6 +/- 3.9 v 25.1 +/- 4.5), WHR (0.89 +/- 0.1 v 0.88 +/- 0.1) and body composition (% body fat (28.7 +/- 8.5 v 29.0 +/- 9.0, lean mass (46.1 +/- 9.3 kg v 47.1 +/- 10.2)) were unchanged. Perceived physical health improved with mean baseline SF-36 PCS scores (41.4 +/- 5.9) becoming similar to population norms at month 6 (50.4 +/- 5.0). Conclusion(s): A program of diet and exercise was generally well tolerated and was associated with trends toward improvement, rather than the usual decline, in metabolic parameters post-transplant. A controlled study is warranted.