Do Exercise, Physical Activity, Dietetic, or Combined Interventions Improve Body Weight in New Kidney Transplant Recipients? A Narrative Systematic Review and Meta-Analysis

Abstract

Weight gain within the first year of kidney transplantation is associated with adverse outcomes. This narrative systematic review and meta-analysis examines the effect of exercise, physical activity, dietary, and/or combined interventions on body weight and body mass index (BMI) within the first year of kidney transplantation. Seven databases were searched from January 1985 to April 2021 (Prospero ID: CRD42019140865), using a ‘Population, Intervention, Controls, Outcome’ (PICO) framework. The risk-of-bias was assessed by two reviewers. A random-effects meta-analysis was conducted on randomized controlled trials (RCTs) that included post-intervention body weight or BMI values. Of the 1197 articles screened, sixteen met the search criteria. Ten were RCTs, and six were quasi-experimental studies, including a total of 1821 new kidney transplant recipients. The sample sizes ranged from 8 to 452. Interventions (duration and type) were variable. Random-effects meta-analysis revealed no significant difference in post-intervention body weight (−2.5 kg, 95% CI −5.22 to 0.22) or BMI (−0.4 kg/m2, 95% CI −1.33 to 0.54). Despite methodological variance, statistical heterogeneity was not significant. Sensitivity analysis suggests combined interventions warrant further investigation. Five RCTs were classified as ‘high-risk’, one as ‘some-concerns’, and four as ‘low-risk’ for bias. We did not find evidence that dietary, exercise, or combined interventions led to significant changes in body weight or BMI post kidney transplantation. The number and quality of intervention studies are low. Higher quality RCTs are needed to evaluate the immediate and longer-term effects of combined interventions on body weight in new kidney transplant recipients.