Positive Effects of Early Intervention of Renal Rehabilitation on Kidney Transplant Patients

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IntroductionRenal rehabilitation (RR) is designed to optimize a renal patient’s physical, psychological, and social function. It also affects on slowing and the progression of renal deterioration, therefore reducing morbidity and mortality. In Japan, RR is getting popular for CKD and ESKD patients recently. On the other hand, RR for kidney transplant (KT) patients performs very few and the role of physical activity in KT patients has been largely overlooked even they are CKD. In this study we evaluate the physical activity of KT patients before and after KT surgery as the first step to estimate the effects of RR for KT patients.Materials and MethodsWe evaluated the physical condition of KT patients before, 1 and 2 months after transplant surgery. The evaluated physical parameters include height, body weight, BMI. We examined patient demographics including age, gender, primary disease, history of dialysis, smoking, laboratory examination data such as anemia / graft function, and complications. Physical functions including 6 minutes walk distance and grip strength / isometric knee extension muscular strength were evaluated. Physical activities; Step count and activity time over medium strength were also measured by pedometer with 3 axis accelerometer at same time except one month after the surgery.Twenty KT patients who underwent KT in our hospital between Jan. 2016 to June 2017 were enrolled with informed consent.The data were analyzed by t-test and variance analysis. Ethical committee of our hospital permitted this study.ResultsDemographic data is shown in table 1.Graft functionAll twenty patients recovered renal function after KT and the average graft function (eGFR ml/min/1.73m2) were 36 and 37 at 1 and 2 months post transplant respectively. Physical function: Average 6 minutes walk distance was 571m before KT and it reduced to 538m at 1 month postoperatively and recovered to 574m after 2 months. Lower limb muscle strength indicated markedly reduced from 57 to 48 Kg (p<0.01) at 1 month after KT and recovered to 51 Kg (p=1.0) in 2 months post KT. However, grip strength kept reducing until 2 months (34, 32, 28 Kg)(p=0.7). Physical activity: Average step count showed 5492 and 4232 at before and 2 months after transplant respectively (p=0.5). Moderate activity time was 15 and 14 minutes at before and after transplantation respectively (p=0.7).DiscussionAlthough we hope that physical function and activity recovered quickly after KT, they did not improve and stayed almost same level in 2 months. We consider that negative effects of KT surgery and following bed rest still remained until 2 months after KT. This result indicates that early intervention of RR can be useful and mandatory. We should evaluate effects of early introduction of RR on physical activity and function and also on graft function both in short and long term.

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