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The following is a summary of “Immunosuppressive therapy and nutritional diseases of patients after kidney transplantation: a systematic review,” published in the January 2025 issue of Nephrology by Kajdas et al.
Kidney transplantation (kTx) is the most effective treatment for end-stage renal disease, requiring immunosuppressive therapy. However, post-transplant patients often experience significant morbidity, including diabetes, anemia, and lipid disorders, increasing cardiovascular risks.
Researchers conducted a retrospective study to summarize the impact of immunosuppressive therapy on nutritional diseases in patients with kTx, highlighting its role in post-transplant outcomes and graft survival.
They conducted a systematic review following the PRISMA 2020 checklist, including observational studies (cohort, case-control, cross-sectional) and RCTs published in English from the past 10 years (up to 17th February 2023). Databases searched included MEDLINE, EMBASE, Scopus, and Web of Science. Quality assessments used ROBINS-I and RoB2 tools. Results were synthesized narratively, with quantitative analysis where feasible. The protocol was published elsewhere.
The results showed that 24 studies (n = 9,536) were included, with 16 cohort studies, most conducted in hospital settings. Most participants were male. Diabetes was the most frequent disease assessed (n = 14), with tacrolimus (Tac) as the most evaluated immunosuppressive (n = 16). Tac was linked to a higher risk of diabetes compared to cyclosporine (CsA) and weight gain, while steroids showed no relationship with weight gain. Everolimus was associated with lipid abnormalities. Non-Calcineurin inhibitors (CNIs) users had a lower prevalence of hypomagnesaemia, hyperkalemia, and metabolic acidosis. CNIs negatively impacted 25-hydroxyvitamin D (25(OH)D) levels. No differences in phase angle, visceral fat area, or lean body mass were observed between slow and fast Tac metabolizers. Mammalian target of rapamycin (mTOR) inhibitors was linked to bone status, and mycophenolate mofetil was associated with vitamin B12 deficiencies.
Investigators found an association between immunosuppressive therapy and nutritional diseases in patients with kTx, with high heterogeneity and low study quality. Future research should focus on high-quality, prospective randomized controlled trials.
Source: bmcnephrol.biomedcentral.com/articles/10.1186/s12882-025-03964-0#Abs1
