Lifestyle Interventions, Markers of Metabolic Syndrome and Quality of Life in Kidney Transplant Recipients: A Systematic Review and Meta-Analysis.

BACKGROUND

Kidney transplantation reduces mortality in patients with kidney failure; however, recipients often experience post-transplant complications, such as weight gain, hypertension, dyslipidaemia and new-onset diabetes mellitus.

OBJECTIVES

To examine the impact of lifestyle interventions (diet, exercise and behavioural) on markers of metabolic syndrome and quality of life (QoL) in kidney transplant recipients.

DESIGN

Systematic review and meta-analysis.

METHODS

Eligible studies were randomised controlled trials assessing the effect of lifestyle interventions on metabolic outcomes (body weight, lipid levels, HbA1c, fasting glucose, blood pressure, albuminuria, proteinuria and C-reactive protein), and QoL in kidney transplant recipients. A systematic search until 27 June 2025 was conducted. Data were synthesised using random-effects meta-analyses, and QoL data were synthesised using a narrative synthesis approach.

RESULTS

A total of 35 studies were included: 13 (37%) of which were exercise interventions, 11 (31%) diet, 2 (6%) behavioural and 9 (26%) were multi-component interventions. Lifestyle intervention resulted in significant reductions in body fat (weighted mean difference: -1.190 kg [95% CI: -2.088 to -0.291]) and significant increases in high-density lipoprotein cholesterol (0.094 mmol/L [95% CI: 0.013, 0.175]), with no other significant changes found. Narrative synthesis found improvements in QoL following lifestyle intervention. Certainty of the body of evidence (assessed using GRADE) ranged from moderate to very low.

CONCLUSION

Lifestyle intervention was found to lead to improvements in body fat (kg), HDL cholesterol and QoL. While these findings suggest some potential benefits of lifestyle intervention, additional research is needed across a range of lifestyle interventions.