Date of Award

12-2018

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Program

Nursing Science

Research Advisor

Donna K. Hathaway Ph.D

Committee

Carolyn J. Graff, Ph.D. Carrie Harvey, Ph.D. Tara O’Brien, Ph.D. George E. Relyea, MS

Keywords

Body Composition, Cardiovascular, Diabetes, Kidney Transplantation, Obestity, Weight Gain

Abstract

BACKGROUND: Weight gain is commonly observed post-kidney transplantation and is associated with unfavorable health outcomes, such as graft loss, new onset diabetes, and cardiovascular disease. The purpose of this study was to determine the most effective measure for assessing body composition after kidney transplantation.

DESIGN: The study was a descriptive correlational follow-up study from a single kidney transplant site.

SUBJECTS: A total of 45 eligible patients from a 2007-2011 parent study were selected, ages of 37 to 78.

MEASUREMENTS: Body composition was obtained 5–8 years posttransplant via anthropometric measures (waist circumference, body mass index, and dual energy X-ray absorptiometry) and compared with baseline (pretransplant) values. Similarly, weight and body mass index (BMI) were obtained. Blood sampling was performed to measure levels of serum glucose, hemoglobin A1C, low-density lipoprotein-cholesterol, high-density lipoprotein, triglycerides, and coronary risk ratio. Kidney function was monitored via serum creatinine. Manual blood pressure was taken with two resting blood pressures.

RESULTS: The sample size was N = 45 and included 29 (64.4%) African Americans and 16 (35.6%) Whites. There were 25 (55.6%) males and 20 (44.4%) females. The ages were 37 to 78, with a mean of 56 (SD =10.1). Body weight increased from 186.66 ± 42.10 at baseline to 197.89 ± 48.1 at the 5-8 year follow-up, and BMI increased from 29.03 ± 4.76 to 32.14 ± 9.61. At the 5-8 year follow-up, anthropometric measure of waist circumference was found to be associated with cardiac risk ratio and weight with diastolic BP. In contrast, 7 body composition measures were associated with HDL, 4 with cardiac risk ratio, 5 with creatinine, and 2 with systolic blood pressure. Significant associations were also found with anthropometric measure BMI obtained at the time of transplant surgery and HDL and LDL 5-8 years later. There were 13 body composition measures associated with HDL, 6 with cardiac risk ratio, and 2 with triglycerides during this same time span. Lastly, one change in anthropometric measure from baseline to 5-8 year posttransplant was associated with the 5-8 year cardiac risk factors (cardiac risk ratio and BMI). There were 18 significant relationships for body compositions measures. These included 7 body composition measures associated with creatinine, 5 with LDL, 4 with diastolic blood pressure, and 2 with triglycerides.

DISCUSSION: The significant relationships found among dual-energy x-ray absorptiometry and cardiac-related outcomes suggest this method may provide a better assessment of body fat, weight gain, and potential cardiac risk factors than does the currently used method. The study continued to examine the use of dual-energy x-ray absorptiometry to better understand the emerging coronary risk that accompanies weight gain and as a basis upon which more precisely targeted interventions could be designed that would improve the health and life expectancy of kidney transplant patients.

ORCID

http://orcid.org/ https://orcid.org/0000-0002-2069-1836

DOI

10.21007/etd.cghs.2018.0471

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