Dietary practices and nutritional strategies after kidney transplantation: A survey of practices among specialized dietitians in France, Belgium, and Luxembourg

Background Nutritional management after kidney transplantation remains heterogeneous despite major metabolic, cardiovascular, and immunological implications related to immunosuppressive therapy. Objective To describe current dietary practices and nutritional strategies implemented after kidney transplantation in France, Belgium, and Luxembourg. Methods A cross-sectional online survey was conducted from June to July 2023 among members of the Association de diététique et nutrition en néphrologie (ADNN) and the Groupe des diététicien(ne)s de néphrologie (GDN, Belgium). The 43-item questionnaire explored consultation modalities, interprofessional coordination, adherence to nutritional recommendations, dietary prescription practices, and participation in therapeutic education programs. The survey was self-administered, and descriptive analyses were expressed as frequencies and percentages. Results Forty-seven dietitians responded (51% from France, 47% from Belgium, 2% from Luxembourg). Most worked in dialysis (80.8%), nephrology (46.8%), or transplantation units (30%). Dietary follow-up of kidney transplant recipients was reported mainly during hospitalization (86.7%), particularly at the time of transplantation, and in outpatient consultations (73.3%) during subsequent weeks or months. Most dietitians reported following fewer than 20 transplant patients per year. Weight changes (94%), post-transplant diabetes (41%), and digestive disorders (14%) were the leading consultation motives. Balanced diets (69%), sodium restriction (56%), and reduced sugar intake (28%) were the main strategies. In the early postoperative phase, a light, then high-protein (67%) and low-microbial (53%) diet was usually prescribed. Strict food safety measures were applied in >90% of centers, typically for six months. Coordination between teams remained limited, with one third reporting no formalized protocol. Conclusion The survey highlights the variability of dietary management after kidney transplantation and the need for standardized nutritional protocols, specific professional training, and improved inter-team coordination.