**2.4 Nutrition therapy in kidney transplant**

Nutrition therapy is very crucial in the acute phase of the post-transplant period (up to eight weeks) to provide adequate nutrition. This would enable wound healing and prevent catabolism, prevent infections, correct clinically significant electrolyte and metabolic abnormalities caused by the immunosuppressive medications, and aid in restoring kidney function. In the chronic phase, nutrition helps to stabilize and prevent deterioration of kidney function and prevents the development of new-onset diabetes after transplant, hypertension, hyperglycemia, anemia, dyslipidemia, and bone disease [25, 26]. Adequate calories are recommended. Therefore, energy requirements should be between 30 and 35 kcal/kg/day and protein 1.2–2.0 g/kg/day in the early period post-transplant [26, 27]. After the first months, protein intake should be reduced to about 0.8 g/kg/day in patients with adequate graft function while adjusting both energy and protein intake for physical activity levels, gender, and age [28]. Some studies suggest that the protein recommendation for the chronic phase post-transplant for the recipients without diabetes should be 0.6–0.8 g/kg/day, while for those with diabetes, it should be 0.8–0.9 g/kg/day [29]. Dietary potassium in the acute phase ranges between 2 and 4 g if the patient has hyperkalemia and unrestricted in the chronic phase unless hyperkalemic. Fluids are generally unrestricted in both phases, and phosphorous should be given as the daily required intake and supplemented if the patient has hypophosphatemia in the acute phase. In the acute phase, sodium should be restricted if blood pressure and fluids dictate in the acute phase while in thechronic phase, sodium should range between 2 and 4 g if the patient has hypertension and/or edema.

Hypophosphatemia is often common in post-transplantation, especially in the first months, and often to lead osteodystrophy and osteomalacia; therefore, it is prudent to prescribe high-phosphorous intake through diet or supplements [3].


The nutrient requirements for each RRT modality are summarized in **Table 1**.


#### **Table 1.**

*Nutrient requirements in different RRT modalities.*
