21. Low protein intake is associated with severe fatigue in stable outpatient renal transplant recipients

A.W. Gomes Neto, M. Geelink, R.M. Douwes, I.M. Vliet, A. Post, J.G.M. Rosmalen, M.L. Joustra, S. P. Berger, G.J. Navis, S.J.L. Bakker

Thursday 5 march 2020

0:00 - 0:00h at Toon Hermans Foyer

Parallel session: Postersessie 5 – Klinische en Verpleegkundige abstracts

Background: Severe fatigue is a frequent complaint in renal transplant recipients (RTR) that is often accompanied by functional impairment and poor quality of life. Low protein intake may lead to protein-energy malnutrition and thereby contribute to fatigue in RTR. We aimed to (1) compare the prevalence of severe fatigue between RTR and healthy controls, (2) investigate impact of severe fatigue on quality of life in RTR, and (3) investigate the association of protein intake with severe fatigue in RTR.

Methods: We included 601 stable RTR with a functioning graft >1 year and 237 kidney donors from the TransplantLines Study (NCT03272841). Fatigue was assessed using the Checklist Individual Strength (CIS) Questionnaire. A CIS-score >76 was considered to indicate fatigue. Quality of Life (QoL) was assessed with the RAND-36 Questionnaire. Patients were instructed to collect 24-hr urine according to a strict protocol and the Maroni formula was used to calculate protein intake from 24-hr urinary urea excretion. Chi-Square was used to test differences in prevalence of severe fatigue in RTR and donors. Linear regression analyses was used to test differences in QoL of RTR with and without severe fatigue. Logistic regression was used to analyze the association between protein intake and presence of severe fatigue.

Results: Thirty-three percent of RTR were severely fatigued compared to 6% of kidney donors (P<0.001). QoL was significantly lower in RTR with compared to RTR without severe fatigue (mean QoL-score 56 [45-71] vs 88 [80-92], P<0.001). Mean protein intake in RTR was 83 ± 22 grams per day; 1.0 ± 0.3 g per kg bodyweight/day. Protein intake was inversely associated with severe fatigue in RTR and remained inversely associated after adjustment for potential confounders including age, ssex, eGFR, BMI, hsCRP, anemia and TSAT (per 0.1 g protein/kg/bw: adjusted HR 0.88; 95%CI 0.80-0.96 and per 10g protein/d: adjusted HR 0.82; 95%CI 0.73-0.93).

Conclusions: Severe fatigue is highly prevalent in RTR and a determinant of poor quality of life. Low protein intake is associated with higher risk of severe fatigue in RTR, independent of potential confounders, including age, sex, eGFR, BMI, and anaemia