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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2018  |  Volume : 29  |  Issue : 4  |  Page : 889-892
Hypervolemia and high tumor necrosis factor-α: An interesting finding during the first six months' posttransplant period in kidney transplant recipients with good renal function

1 Department of Nephrology, Faculty of Medicine, Cukurova University, Adana, Turkey
2 Central Laboratory Immunology, Faculty of Medicine, Cukurova University, Adana, Turkey

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Date of Submission25-Sep-2017
Date of Decision30-Oct-2017
Date of Acceptance04-Dec-2017
Date of Web Publication28-Aug-2018


Renal transplantation is the treatment of choice for the end-stage renal disease. Hypervolemia and inflammation are commonly overlooked. We investigated whether hyper-volemia develops in kidney transplant recipients with estimated glomerular filtration rate (eGFR) >70 mL/min and if there is there any correlation between inflammatory cytokines and hypervolemia in the 1st month and at six months after transplantation. We measured serum tumor necrosis factor-α (TNF-α), interleukin (IL)-1, IL-6, and body composition indices in 11 healthy volunteers and 19 kidney transplant recipients (KTRs) with eGFR >70 mL/min at one month and six months posttransplant. At baseline, body mass index (BMI) and fat tissue index (FTI) were significantly higher and overhydration improved (P = 0.006) at 6th month in KTRs. There was no difference in BMI, FTI, lean tissue index (LTI), and serum levels of IL-1 and IL-6 in controls and KTRs at six months posttransplant. Volume overload and serum TNF-α levels were significantly lower in controls than KTRs. There was positive correlation between volume overload and serum TNF-α levels in KTRs. Compared to baseline, parameters including volume overload, BMI, and FTI were found to be improved at six months' posttransplant in KTRs. Interestingly, volume overload and high levels of serum TNF-α continued at least six months after transplantation.

How to cite this article:
Paydas S, Karaer R, Çentiner S. Hypervolemia and high tumor necrosis factor-α: An interesting finding during the first six months' posttransplant period in kidney transplant recipients with good renal function. Saudi J Kidney Dis Transpl 2018;29:889-92

How to cite this URL:
Paydas S, Karaer R, Çentiner S. Hypervolemia and high tumor necrosis factor-α: An interesting finding during the first six months' posttransplant period in kidney transplant recipients with good renal function. Saudi J Kidney Dis Transpl [serial online] 2018 [cited 2022 Aug 8];29:889-92. Available from: https://www.sjkdt.org/text.asp?2018/29/4/889/239660

   Introduction Top

Renal transplantation is the optimal treatment for end-stage renal failure. However, cardiovascular disease is still a serious problem after transplantation. Malnutrition and hypervolemia are important factors for cardiovascular disease in addition to other risk factors.

The determination of body composition by bioimpedance device is a simple and noninvasive procedure. The purpose of this study was to evaluate serum levels of inflammatory cytokines and body composition in kidney transplant recipients (KTRs) during six months' period after transplantation.

   Patients and Methods Top

Nineteen KTRs with estimated glomerular filtration rate (eGFR) >70 mL/min (female/ male ratio 6/13) and 11 healthy controls (female/male ratio 9/2) were included in this study. KTRs with rejection, heart failure, infection, malignant disease, uncontrolled hypertension, hepatitis, and any adverse events were excluded from the study. All KTRs were on three immunosuppressive drug regimen including mycophenolate mofetil, prednisone, and tacrolimus. KTRs received induction therapy including pulse steroids and daclizumab or anti-thymocyte globulin (ATG; two patients). Body composition was measured by bio-impedance device (Fresenius BCM) at one and six months after transplantation and also healthy volunteers. Biochemical parameters were measured simultaneously. Inflammatory cytokines including IL-1, IL-6, and tumor necrosis factor-α (TNF-α) were measured by ELISA test. (DIA source ImmunoAsays S.A., BELGIUM). According to the kit catalog (for guidance), the mean levels of IL-6, IL-β, and TNF-α were (0–50) <17 pg/mL, 0–13.6 pg/mL, and 4.6–12.4 pg/mL, respectively. The eGFR was calculated by the formula of the Modification of Diet in Renal Disease.

Written informed consent was taken from all patients and healthy volunteers. This study was approved by the Institutional Review Board (IRB) Ethics Committee (meeting number 4 dated January 5, 2012).

   Statistical Analysis Top

The Statistical Package for Social Sciences (SPSS) version 16.0 for Windows (SPSS Inc., Chicago, IL, USA) was used. P <0.05 was considered statistically significant. All parameters were shown as mean ± standard deviation.

   Results Top

The body composition indices, serum levels of biochemical parameters, and inflammatory cytokines are shown in [Table 1]. Serum TNF-α levels were found to be significantly high in KTRs compared with healthy controls. Correlation analysis revealed a positive correlation between TNF-α and volume overload (r = 0.657 and P = 0.002).
Table 1: The body composition indices and serum levels of biochemical parameters and inflammatory cytokines of healthy volunteers and kidney transplant recipients in 1 and 6 months.

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   Discussion Top

Cardiovascular events are frequent in endstage renal disease and malnutrition, and inflammation and overhydration are important risk factors in these cases. KTRs gain weight due to increased appetite improved renal function and steroid use during the posttransplant period. At six months' posttransplant, the BMI in our patients increased and became similar to that of healthy individuals. When we considered body composition, increased fat mass index and volume overload decreased as reported in earlier studies.[1],[2],[3] However, muscle mass index did not change after six months of transplantation when compared to baseline and healthy volunteers. Results about body mass index have been found to be conflicting and represent increase, decrease, or no change.[1],[2],[3]

This finding has been explained as predni-solone effect on muscle mass. El Haggan et al found that body weight in the 2nd year of transplantation did not change while total lean mass increased significantly in cases with discontinuation of prednisone but did not change in cases continuing prednisone.[4] In our study, body mass index and fat and muscle mass indices were similar in healthy individuals and KTRs at the end of six months. However, at six months, volume overload was higher in KTRs than that of healthy volunteers. Inflammatory markers except TNF-α were similar in the two groups. The volume overload was found to be correlated with serum TNF-α levels.

In KTRs, as compared to baseline levels, biochemical parameters except uric acid improved at 6th month. In healthy volunteers, the levels of blood urea nitrogen (BUN), creatinine, and uric acid were lower than that of KTRs during six months' posttransplant; however, the serum phosphorus was found to be higher although all parameters were within normal limits. In another study, hypervolemia was also found to be unexpectedly common (30%) among clinically stable KTRs.[5]

In conclusion, the indices of body composition and biochemical and inflammatory parameters were found to be improved in KTRs with eGFR >70 mL/min while overhydration and higher serum TNF-α levels were still persistent at six months of renal transplantation. There was a positive correlation between volume overload and serum TNF-α levels. We have to advise patients in the posttransplant period to avoid compulsive water drinking since more liquid consumption can cause overhydration and indirectly accompanying increase of serum TNF-α levels in kidney transplant recipients, at least, in the first six months.

   Funding and Support Top

This study was supported by Cukurova University Research Fund (TF 02012 BAP4 B).

Conflict of interest: None declared.

   References Top

Netto MC, Alves-Filho G, Mazzali M. Nutritional status and body composition in patients early after renal transplantation. Transplant Proc 2012;44:2366-8.  Back to cited text no. 1
Harada H, Nakamura M, Hotta K, et al. Percentages of water, muscle, and bone decrease and lipid increases in early period after successful kidney transplantation: A body composition analysis. Transplant Proc 2012; 44:672-5.  Back to cited text no. 2
Dolgos S, Hartmann A, Jenssen T, et al. Determinants of short-term changes in body composition following renal transplantation. Scand J Urol Nephrol 2009;43:76-83.  Back to cited text no. 3
El Haggan W, Hurault de Ligny B, et al. The evolution of weight and body composition in renal transplant recipients: Two-year longitudinal study. Transplant Proc 2006;38:3517-9.  Back to cited text no. 4
Chan W, Bosch JA, Jones D, et al. Hypervolemia and blood pressure in prevalent kidney transplant recipients. Transplantation 2014;98:320-7.  Back to cited text no. 5

Correspondence Address:
Prof. Saime Paydas
Department of Nephrology, Faculty of Medicine, Cukurova University, Adana
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1319-2442.239660

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