2/29/2020
                                     Nutrition in Solitary Kidney Care and Kidney 
                                                                  Transplantation
                                       “Opportunity to mitigate poor outcomes in 
                                     individuals who give and persons who take”
                                                           Ekamol Tantisattamo, MD, FASN, FAST
                                                                       Transplant nephrologist
                                                               Assistant Clinical Professor of Medicine
                                                   Division of Nephrology, Hypertension and Kidney Transplantation
                                                                       Department of Medicine
                                                           University of California Irvine School of Medicine 
                                                        Nutritional and Dietary Management of Kidney Disease: 
                                                                      A Patient Care Approach 
                                                                                         th                                1
                                                                    Saturday, February 29 , 2020       COPY
                                                                    Disclosure
                                        • None NOT 
                      DO                                                                                                   2
                                                                                                                                                           1
                                                                                         2/29/2020
                                              Outline
                         • Solitary kidney
                            –Epidemiology
                            –Etiology
                         • Living kidney donor
                            –Complications
                            –Nutritional management
                         • Kidney transplant recipient
                            –Outcomes
                            –Food security
                            –Nutrition management                            3
                                                                 COPY
                                    Why only 1 kidney?
                                    NOT 
              DO                                                             4
                                                                                                 2
                                                                                                                                                                                                         2/29/2020
                                                   Epidemiology of adult non-transplant solitary kidney 
                                                                                                  Acquired solitary 
                                                                                                              kidney
                                                                           Renal trauma                         Kidney                       Renal cancer
                                                                                                               donation
                                                                                                  Average nephrectomy / year
                                                                           •   126 / y 1                  •   5,650 / y 2                        •  269 / y 3
                                                                             •   31 y/o M                  •   35 – 45 y/o F                      •   >60 y/o
                                                                                1McClung et al. J Trauma Acute Care Surg. 1262 2013;75:602–606. 
                                                                                   2Hart et al. Kidney. Am J Transplant. 2019;19 Suppl 2:19-123.
                                                                                            3Shuch et al. Cancer. 2013;119:2981–2989.                                         5
                                                                                                                                                  COPY
                                                                   Options for ESRD patients
                                                                                                    End‐stage renal disease
                                                                       Conservative                  Dialysis                        Kidney                Artificial 
                                                                                                                                  transplant                kidney
                                                                                                         Hemodialysis                     Living 
                                                                                NOT 
                                                                                                                                          donor
                                                                                                       Peritoneal                         Deceased 
                                                                                                          dialysis                      (Cadaveric) 
                                                                                                                                            donor
                                                                                                                                       Tolerance
                                                                         Courtesy from Dr. John Friedewald, Comprehensive Transplant Center Northwestern University           6
                               DO                                                                                                                                                                                          3
                                                                                                                                                                                                                                                                                     2/29/2020
                                                                                                              Living kidney donor
                                                                                                                                “Dedicated to true heroes
                                                                                                                                Those who give without wanting
                                                                                                                                Those who receive without forgetting”
                                                                                                                                                                                UCSF Transplant Center
                                                                                                                                                                                                                                                 7
                                                                                                                                                                                                         COPY
                                                                                 Care for living kidney donors
                                                                                        PrPree‐‐donadonationtion                                                                        PoPosstt‐‐dondonaationtion
                                                                                    ••     CarCarddioiovvaasculascularr                                                               ••     HypertHypertensionension
                                                                                    ••     PsycPsychhoo‐‐socialsocial                                                                 ••     ObesityObesity
                                                                                                              NOT 
                                                                                    ••     HypertHypertensionension                                                                   ••     CKDCKD  (pr(prootteinuria),einuria),  
                                                                                    ••     ObesityObesity                                                                                    ESESRRDD
                                                                                                                                                                                      ••     PsycPsychhoo‐‐socialsocial
                                                                                                                    PrPrototeinein                                                          SodiumSodium
                                          DO                                                                                                                                                                                                     8
                                                                                                                                                                                                                                                                                                               4