Weight trends in living kidney donors suggest predonation counselling alone lacks a sustainable effect on weight loss: a single centre cohort study.

Living kidney donors are at risk of long-term end-stage renal disease, and obesity is an independent risk factor. In our centre, predonation counselling of obese donors concentrates on lifestyle modifications, particularly weight loss and exercise. Whether these recommendations have a sustainable effect after donation remains unknown. We conducted a retrospective analysis of all donors who proceeded to donation between 2012 and 2016. Donors' body mass index (BMI) was compared between predefined time points using matched pair analysis. Among 303 donors included, 15% were obese at initial assessment. Obese donors were observed to lose weight by the time of donation (mean BMI difference 1.32 kg/m2 , P < 0.001), but bounced back to their initial weight at one-year postdonation (mean BMI difference + 1.47 kg/m2 , P < 0.001), which was maintained at two-year postdonation. While 71% of obese donors lost weight by the time of donation, 56% of them gained that weight back at one year. Our findings underline the success of predonation counselling on lifestyle modification in highly motivated obese donors, although additional strategies are required to sustain weight loss. The impact of weight gain on long-term risk needs further evaluation. Living donor programmes should provide continued support with lifestyle modifications after donation.

Exploring the emotional impact of axial Spondyloarthritis: a systematic review and thematic synthesis of qualitative studies and a review of social media.

BACKGROUND: The psychological burden in people with inflammatory arthritis is substantial, yet little is known about the disease-related affect experienced by individuals with axial Spondyloarthritis (axial SpA). The aim of this study was to conduct a qualitative evidence synthesis and a review of social media to explore the emotional impact of living with axial SpA. METHODS: We searched nine databases for studies reporting qualitative data about participants' emotional experience of living with axial SpA. In addition, we searched social media platforms for posts from people with axial SpA based in the UK that offered insights into emotional responses to living with the condition. We employed a thematic approach to synthesise the data. RESULTS: We included 27 studies (1314 participants; 72% men) in our qualitative evidence synthesis and developed seven descriptive themes from the data: 1) delayed diagnosis: a barrier to emotional wellbeing; 2) disruptive symptoms: a source of mood swings; 3) work disability: a loss of self-esteem; 4) obstacles in interpersonal relationships: a trigger of distress; 5) taking up exercise: personal pride or unwelcomed reminders; 6) anti-TNF therapy: hope reignited despite concerns and 7) a journey of acceptance: worry mixed with hope. Posts extracted from social media fora (537; 48% from women) for the most part supported the seven themes. One additional theme-COVID-19, uncertainty and anxiety during the pandemic, was developed, reflecting common emotions expressed during the UK's first wave of the coronavirus pandemic. CONCLUSION: This study highlights a preponderance of negative affect experienced by people living with axial SpA, conditioned through existing and anticipated symptoms, failed expectations, and lost sense of self. Given the bidirectional relationships between negative emotions and inflammation, negative emotions and perceptions of pain, and the influence of affect in self-care behaviours, this finding has important implications for treatment and management of people with axial SpA.