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de Waal D, Onuigbo M, Golper TA. Case Study: The Weighty Issue of Treatment Options for Obese Dialysis Patients. J Ren Nutr 2024:S1051-2276(24)00065-7. [PMID: 38685393 DOI: 10.1053/j.jrn.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 04/13/2024] [Accepted: 04/15/2024] [Indexed: 05/02/2024] Open
Abstract
Obesity is a complex chronic disease and common comorbidity in kidney failure and is the leading causes of death and disability in this population. Guidelines do not specifically address the preferred weight management option(s) for obesity while on dialysis. Large body size is a limiting factor for consideration of a kidney transplantation. We report on a successful bariatric surgery with a young adult after 5.5 years on dialysis with hope for a future transplant. Success was demonstrated with progressive weight loss without adverse changes in renal clinical markers accompanied by improvements in exercise tolerance and health status thereby improving her suitability for a kidney transplant. Further studies and guidelines are needed to address weight loss options for those with obesity on dialysis and want to lose weight.
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Affiliation(s)
- Desiree de Waal
- Nephrology Services, University of Vermont Medical Center, Nephrology, Burlington, VT.
| | - Macaulay Onuigbo
- Division of Nephrology, Department of Medicine, University of Vermont Medical Center, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT
| | - Thomas Alan Golper
- Division of Nephrology, Department of Medicine, University of Vermont Medical Center, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT
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2
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Verras GI, Mulita F, Lampropoulos C, Kehagias D, Curwen O, Antzoulas A, Panagiotopoulos I, Leivaditis V, Kehagias I. Risk Factors and Management Approaches for Staple Line Leaks Following Sleeve Gastrectomy: A Single-Center Retrospective Study of 402 Patients. J Pers Med 2023; 13:1422. [PMID: 37763189 PMCID: PMC10532722 DOI: 10.3390/jpm13091422] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/26/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
Sleeve gastrectomy (SG) has gained ever-increasing popularity among laparoscopic surgeons involved in bariatric surgery. This single-institution, retrospective cohort study aims to evaluate the prevalence of postoperative staple line leakage (PSLL) after LSG and identify risk factors for its development. We included patient data that underwent LSG at our institution for a span of 17 years-starting in January 2005 and ending in December 2022. We set the investigation of correlations of patient-related factors (age, weight, BMI, smoking status, presence of diabetes mellitus) with the occurrence of postoperative leaks. A total of 402 patients were included in our study. Of them, 26 (6.46%) developed PSLL. In total, 19 (73%) patients underwent percutaneous drainage and 14 patients (53.8%) were treated with intraluminal endoscopic stenting. Finally, five patients (19.2%) were treated with endoscopic clipping of the defect. Operative management was required in only one patient. There were no statistically significant differences in patient age, mean weight at the time of operation, and mean BMI. Abnormal drain amylase levels were associated with earlier detection of PSLL. More consideration needs to be given to producing a consensus regarding the management of PSLL, prioritizing nonoperative management with the combination of percutaneous drainage and endoscopic stenting as the safest and most efficient approach.
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Affiliation(s)
- Georgios-Ioannis Verras
- Department of Surgery, General University Hospital of Patras, 26504 Patras, Greece
- General Surgery, Epsom and St. Helier University Hospitals, National Health Service (NHS) Trust, London SM5 1AA, UK
| | - Francesk Mulita
- Department of Surgery, General University Hospital of Patras, 26504 Patras, Greece
| | | | - Dimitrios Kehagias
- Department of Surgery, General University Hospital of Patras, 26504 Patras, Greece
| | - Oliver Curwen
- General Surgery, Epsom and St. Helier University Hospitals, National Health Service (NHS) Trust, London SM5 1AA, UK
| | - Andreas Antzoulas
- General Surgery, Epsom and St. Helier University Hospitals, National Health Service (NHS) Trust, London SM5 1AA, UK
| | - Ioannis Panagiotopoulos
- Department of Cardiothoracic Surgery, General Hospital of Athens “Ippokrateio”, 11527 Athens, Greece
| | - Vasileios Leivaditis
- Department of Cardiothoracic and Vascular Surgery, Westpfalz-Klinikum, 67655 Kaiserslautern, Germany
| | - Ioannis Kehagias
- Department of Surgery, General University Hospital of Patras, 26504 Patras, Greece
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3
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Khajeh E, Aminizadeh E, Dooghaie Moghadam A, Sabetkish N, Abbasi Dezfouli S, Morath C, Zeier M, Nickel F, Billeter AT, Müller-Stich BP, Mehrabi A. Bariatric surgery in patients with obesity and end-stage renal disease. Surg Obes Relat Dis 2023; 19:858-871. [PMID: 36801168 DOI: 10.1016/j.soard.2023.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/03/2022] [Accepted: 01/14/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Bariatric surgery has been suggested as a treatment for obesity and end-stage renal disease (ESRD). Although the number of bariatric surgeries in patients with ESRD is increasing, its safety and effectiveness in these patients are still controversial and the surgical method of choice in these patients is under debate. OBJECTIVES To compare the outcomes of bariatric surgery between patients with and without ESRD and to assess different methods of bariatric surgery in patients with ESRD. SETTING Meta-analysis. METHODS A comprehensive search was conducted in Web of Science and Medline (via Pubmed) until May 2022. Tow meta-analyses were performed: A) to compare bariatric surgery outcomes among patients with and without ESRD, and B) to compare outcomes of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in patients with ESRD. Using a random-effect model, odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were computed for surgical and weight loss outcomes. RESULTS Of 5895 articles, 6 studies were included in meta-analysis A and 8 studies in meta-analysis B. The risk of bias was moderate to serious among studies. Major postoperative complications (OR = 2.82; 95% CI = 1.66-4.77; P = .0001), reoperation (OR = 2.66; 95% CI = 1.99-3.56; P < .00001), readmission (OR = 2.37; 95% CI = 1.55-3.64; P < .0001), and in-hospital/90-d mortality (OR = 4.03; 95% CI = 1.80-9.03; P = .0007) were higher in patients with ESRD. Patients with ESRD also had a longer hospital stay (MD = 1.23; 95% CI = .32-2.14; P = .008). Bleeding, leakage, and total weight loss were comparable among groups. SG showed a 10% lower rate of overall complications and significantly shorter hospital stay than RYGB did. The quality of evidence was very low for the outcomes CONCLUSIONS: Bariatric surgery in patients with ESRD seems to have higher rates of major complications and perioperative mortality than in patients without ESRD, but a comparable rate of overall complications. SG has fewer postoperative complications and could be the method of choice in these patients. These findings should be interpreted cautiously in light of the moderate to high risk of bias in most included studies.
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Affiliation(s)
- Elias Khajeh
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Ehsan Aminizadeh
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Arash Dooghaie Moghadam
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Nastaran Sabetkish
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Sepehr Abbasi Dezfouli
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Christian Morath
- Department of Nephrology, University Hospital Heidelberg, Heidelberg, Germany
| | - Martin Zeier
- Department of Nephrology, University Hospital Heidelberg, Heidelberg, Germany
| | - Felix Nickel
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Adrian T Billeter
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Beat Peter Müller-Stich
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany.
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4
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Impact of Recipient Obesity on Kidney Transplantation Outcome: A Retrospective Cohort Study with a Matched Comparison. Transplant Proc 2022; 54:1786-1794. [DOI: 10.1016/j.transproceed.2022.03.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/15/2022] [Accepted: 03/26/2022] [Indexed: 11/19/2022]
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5
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Schrauben SJ, Apple BJ, Chang AR. Modifiable Lifestyle Behaviors and CKD Progression: A Narrative Review. KIDNEY360 2022; 3:752-778. [PMID: 35721622 DOI: 10.34067/kid.0003122021] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 01/07/2022] [Indexed: 12/19/2022]
Abstract
Living a healthy lifestyle is one of the safest and most cost-effective ways to improve one's quality of life and prevent and/or manage chronic disease. As such, current CKD management guidelines recommend that patients adhere to a healthy diet, perform ≥150 minutes per week of physical activity, manage their body weight, abstain from tobacco use, and limit alcohol. However, there are limited studies that investigate the relationship between these lifestyle factors and the progression of CKD among people with established CKD. In this narrative review, we examine the reported frequencies of health lifestyle behavior engagement among individuals with non-dialysis-dependent CKD and the existing literature that examines the influences of diet, physical activity, weight management, alcohol consumption, and tobacco use on the progression of CKD, as measured by decline in GFR, incident ESKD, or elevated proteinuria or albuminuria in individuals with CKD. Many of the available studies are limited by length of follow-up and small sample sizes, and meta-analyses were limited because the studies were sparse and had heterogeneous classifications of behaviors and/or referent groups and of CKD progression. Further research should be done to determine optimal methods to assess behaviors to better understand the levels at which healthy lifestyle behaviors are needed to slow CKD progression, to investigate the effect of combining multiple lifestyle behaviors on important clinical outcomes in CKD, and to develop effective techniques for behavior change. Despite the lack of evidence of efficacy from large trials on the ability of lifestyle behaviors to slow CKD progression, maintaining a healthy lifestyle remains a cornerstone of CKD management given the undisputed benefits of healthy lifestyle behaviors on cardiovascular health, BP control, and survival.
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Affiliation(s)
- Sarah J Schrauben
- Renal, Electrolyte-Hypertension Division, Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Benjamin J Apple
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
| | - Alex R Chang
- Kidney Health Research Institute, Department of Population Health Sciences, Geisinger Health, Danville, Pennsylvania
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Al-Sumaih I, Donnelly M, O'Neill C. Sociodemographic characteristics of patients and their use of post-bariatric contouring surgery in the US. BMC Health Serv Res 2022; 22:308. [PMID: 35255893 PMCID: PMC8900300 DOI: 10.1186/s12913-022-07692-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 02/17/2022] [Indexed: 11/29/2022] Open
Abstract
Background Expansion of healthcare insurance coverage to bariatric surgeries has led to an increased demand from patients for post-bariatric contouring surgeries. This study examined the relationship between the use of contouring procedures on post-bariatric surgery patients, clinical need and sociodemographic factors. Methods Data were extracted from the Healthcare Cost and Utilization Project (HCUP) Nationwide Ambulatory Surgery Sample (NASS) regarding hospital-owned ambulatory surgical centres in the US. Episodes without missing values relating to patients, 18 years old or above were the primary unit of analysis. Episodes were excluded if the field regarding expected payer was reported as “no charge.” The primary outcome was the likelihood of panniculectomy, abdominoplasty, and mastopexy among post-bariatric surgery patients; and the degree to which uptake of these types of contouring surgery were associated with age, gender, median households’ income, expected payer, patient’s location, and comorbidity. Results A total of 66,368 weighted episodes of care received by patients who had had bariatric surgery were extracted (54,684 female [82.4%]; mean age, 51.3 [SD, 12.1]; 6219 episodes had contouring surgeries [9.37%]). Panniculectomy was the most common post-bariatric contouring procedure (3.68%). Uptake of post-bariatric contouring procedures was associated with age, sex, payment type, area-based measures of median household income, and patient location. Compared to Medicare insured patients, the odds of receiving contouring surgery among self-payers were 1.82 (95% CI, 1.47 to 2.26) for panniculectomy, 14.79 (95% CI, 12.19 to 17.93) for abdominoplasty and 47.97 (95% CI, 32.76 to 70.24) for mastopexy. Rank order of comorbidity profiles also differed between insured and self-paying recipients of contouring surgery. Conclusions Insurance status of bariatric surgery patients and their sex were strongly associated with receipt of a range of contouring procedures. Self-payments were associated with a doubling of the odds of having panniculectomy and an increase in the odds to approximately 14 times for abdominoplasty and 48 times for mastopexy. Thus, access to contouring surgery by post-bariatric patients may be disproportionately dependent on personal preference supported by ability to pay rather than clinical need. Further research is needed to examine the impact of contouring or delayed/denied contouring on health status. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07692-1.
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Affiliation(s)
- Ibrahim Al-Sumaih
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Institute of Clinical Sciences, Queen's University Belfast, Block B, Royal Victoria Hospital, Belfast, UK, BT12 6BA, UK. .,Ministry of Health, Riyadh, Saudi Arabia.
| | - Michael Donnelly
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Institute of Clinical Sciences, Queen's University Belfast, Block B, Royal Victoria Hospital, Belfast, UK, BT12 6BA, UK
| | - Ciaran O'Neill
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Institute of Clinical Sciences, Queen's University Belfast, Block B, Royal Victoria Hospital, Belfast, UK, BT12 6BA, UK
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Baker LA, March DS, Wilkinson TJ, Billany RE, Bishop NC, Castle EM, Chilcot J, Davies MD, Graham-Brown MPM, Greenwood SA, Junglee NA, Kanavaki AM, Lightfoot CJ, Macdonald JH, Rossetti GMK, Smith AC, Burton JO. Clinical practice guideline exercise and lifestyle in chronic kidney disease. BMC Nephrol 2022; 23:75. [PMID: 35193515 PMCID: PMC8862368 DOI: 10.1186/s12882-021-02618-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 11/22/2021] [Indexed: 12/13/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - Mark D. Davies
- Betsi Cadwaladr University Health Board and Bangor University, Bangor, UK
| | | | | | | | | | | | - Jamie H. Macdonald
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | | | | | - James O. Burton
- University of Leicester and Leicester Hospitals NHS Trust, Leicester, UK
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8
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Sleeve gastrectomy in subjects with severe obesity and baseline chronic kidney disease improves kidney function independently of weight loss. A propensity score matched analysis. Surg Obes Relat Dis 2022; 18:772-778. [DOI: 10.1016/j.soard.2022.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/25/2022] [Accepted: 02/05/2022] [Indexed: 12/25/2022]
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9
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Development of consensus-derived quality indicators for laparoscopic sleeve gastrectomy operative reports. Surg Endosc 2021; 36:4969-4976. [PMID: 34782964 DOI: 10.1007/s00464-021-08853-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Synoptic operative reporting has been used as a solution to the poor quality of narrative reports. The aim of this study was to develop operative report quality indicators for the laparoscopic sleeve gastrectomy and to generate parameters by which these reports can be evaluated and improved. METHODS A Delphi protocol was used to determine quality indicators for LSG. Bariatric surgeons across Canada were recruited along with key physician stakeholders to participate via a secure web-based platform. Transferrable consensus items for LSG from previously developed Roux-en-Y gastric bypass operative indictors were put forward for consideration. Participants also initially submitted potential QIs. These were grouped by theme. Items were rated on 5-point Likert scales in subsequent rounds. Scores of 70% or higher were used for inclusion and 30% or less denoted exclusion. Elements scoring 30% to 70% agreement were recirculated by runoff in subsequent rounds to generate the final list of quality indicators. RESULTS Seven bariatric surgeons, representing all regions preforming LSG in Canada, were invited to participate in the Delphi group. Multidisciplinary invitees included one academic minimally invasive/acute care surgeon, one tertiary abdominal radiologist, and one academic gastroenterologist with bariatric expertise. Two rounds were required to achieve consensus. Both rounds achieved a 100% response (10/10). In round 1, forty items reached consensus. In Round 2, an additional 28 items reached consensus, with three items excluded, bringing the total number of quality indicators to 65. CONCLUSION This study establishes consensus-derived multidisciplinary quality indicators for LSG operative reports. Application of these findings aims to advance the quality and completeness of operative reporting in LSG in order to improve communication of important surgical details and quality measures to the multidisciplinary team involved in bariatric surgery care.
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10
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Ku E, McCulloch CE, Roll GR, Posselt A, Grimes BA, Johansen KL. Bariatric surgery prior to transplantation and risk of early hospital re-admission, graft failure, or death following kidney transplantation. Am J Transplant 2021; 21:3750-3757. [PMID: 34331744 PMCID: PMC10184683 DOI: 10.1111/ajt.16779] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/05/2021] [Accepted: 07/22/2021] [Indexed: 01/25/2023]
Abstract
Bariatric surgery has been shown to be safe in the dialysis population. Whether bariatric surgery before kidney transplantation influences posttransplant outcomes has not been examined nationally. We included severely obese (BMI >35) dialysis patients between 18 and 70 years who received a kidney transplant according to the US Renal Data System. We determined the association between history of bariatric surgery and risk of 30-day readmission, graft failure, or death after transplantation using multivariable logistic, Fine-Gray, and Cox models. We included 12 573 patients, of whom 503 (4%) received bariatric surgery before transplantation. Median age at transplant was 53 years; 42% were women. Overall, history of bariatric surgery was not statistically significantly associated with graft failure (HR 1.02; 95% CI 0.77-1.35) or death (HR 1.10; 95% CI 0.84-1.45). However, sleeve gastrectomy (vs. no bariatric surgery) was associated with lower risk of graft failure (HR 0.39; 95% CI 0.16-0.95). In conclusion, history of bariatric surgery prior to kidney transplantation was not associated with allograft or patient survival, but findings varied by surgery type. Sleeve gastrectomy was associated with better graft survival and should be considered in severely obese transplant candidates receiving dialysis.
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Affiliation(s)
- Elaine Ku
- Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, California.,Division of Pediatric Nephrology, Department of Pediatrics, University of California San Francisco, San Francisco, California.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Garrett R Roll
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Andrew Posselt
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Barbara A Grimes
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Kirsten L Johansen
- Division of Nephrology, Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
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11
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Abstract
Obesity-related glomerulopathy (ORG) and other obesity-associated kidney diseases pose a major challenge to the treating nephrologist. We review the benefits of weight loss and optimal management of ORG and kidney disease in the setting of obesity. Therapeutic strategies in ORG were limited mainly in the past to weight loss through lifestyle interventions and bariatric surgery, antihypertensive treatment, and renin-angiotensin-aldosterone system blockade. Current approaches to obtain the desired weight loss include novel pharmacologic therapies that have been approved for the treatment of diabetes while offering kidney protection, such as sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1-receptor agonists. This review focuses on the nephroprotective role of the renin-angiotensin-aldosterone system blockade and of these new pharmacologic agents, and on the renal effects of bariatric surgery in chronic kidney disease.
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Affiliation(s)
- Michal Herman-Edelstein
- Nephrology Department, Rabin Medical Center, Petach Tikva, Israel; Nephrology Research Laboratory, Felsenstein Medical Research Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Talia Weinstein
- Department of Nephrology and Hypertension, Tel Aviv Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
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12
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Vranic G, Cooper M. But Why Weight: Understanding the Implications of Obesity in Kidney Transplant. Semin Nephrol 2021; 41:380-391. [PMID: 34715967 DOI: 10.1016/j.semnephrol.2021.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Obesity is increasing in prevalence among candidates for kidney transplant. Understanding the influence of obesity on candidate evaluation, surgical risk, peritransplant management, and post-transplant outcomes is critical to ensuring equitable access to transplant for this growing population.
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Affiliation(s)
- Gayle Vranic
- MedStar Georgetown Transplant Institute, Georgetown University, Washington, DC.
| | - Matthew Cooper
- MedStar Georgetown Transplant Institute, Georgetown University, Washington, DC
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13
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Choudhury D, Yalamanchili HB, Hasan A. Dialysis of the Obese Patient: Meeting Needs for a Growing Epidemic. Semin Nephrol 2021; 41:371-379. [PMID: 34715966 DOI: 10.1016/j.semnephrol.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Increasing population obesity and associated metabolic consequences has led to increased number of obese patients with chronic kidney disease and end-stage renal disease. While obesity is associated with increased cardiovascular morbidity and mortality, obese dialysis patients present a seeming paradox for survival benefit, given other acute intervening illnesses for those on dialysis with loss of lean body mass overtime. Challenges remain in providing adequate renal replacement options and therapy for this growing segment of obese patients on dialysis which are discussed in this article.
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Affiliation(s)
- Devasmita Choudhury
- Department of Medicine, Division of Nephrology, Salem Veterans Affairs Health System, Salem, VA; Department of Medicine, Division of Nephrology, Virginia Tech Carilion School of Medicine, Roanoke, VA; Department of Medicine, Division of Nephrology, University of Virginia School of Medicine, Charlottesville, VA.
| | - Hima Bindu Yalamanchili
- Department of Medicine, Division of Nephrology, Salem Veterans Affairs Health System, Salem, VA; Department of Medicine, Division of Nephrology, Virginia Tech Carilion School of Medicine, Roanoke, VA
| | - Alia Hasan
- Department of Medicine, Division of Nephrology, Salem Veterans Affairs Health System, Salem, VA
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14
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Affiliation(s)
- Stephen McDonald
- ANZDATA Registry, SA Health and Medical Research Institute, Australia; School of Medicine, University of Adelaide, Australia; Central Northern Adelaide Renal and Transplantation Service, Australia.
| | - Maleeka Ladhani
- School of Medicine, University of Adelaide, Australia; Central Northern Adelaide Renal and Transplantation Service, Australia
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15
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Funes DR, Blanco DG, Hong L, Lo Menzo E, Szomstein S, Rosenthal RJ. Prevalence of chronic kidney disease and end-stage renal disease in a bariatric versus nonbariatric population: a retrospective analysis of the U.S. National Inpatient Sample database. Surg Obes Relat Dis 2021; 18:281-287. [PMID: 34756566 DOI: 10.1016/j.soard.2021.09.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 09/10/2021] [Accepted: 09/26/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND In the past five 5 years our team has studied the effects of bariatric surgery on chronic kidney disease (CKD) at our institution. OBJECTIVES The objective of this study was to assess the impact of bariatric surgery (BaS) on the prevalence and likelihood of CKD and end-stage renal disease (ESRD) nationwide. SETTING Academic hospital, United States. METHODS We conducted a retrospective analysis of the U.S. National Inpatient Sample (NIS) database for the years 2010-2015 and compared. Univariate and multivariable analysis were performed to assess the impact of BaS on the point prevalence and the probability of CKD and ESRD. Similarly, a multivariable logistic regression was conducted to measure the impact of the most important risk factors for CKD exclusively in a severely obese population. RESULTS Data on 296,041 BaS cases and 2,004,804 severely obese controls was extracted from the NIS database and relative to controls, all baseline CKD risk factors were less common among bariatric surgery cases. Nonetheless, even after adjusting for all CKD risk factors, controls exhibited marked increases in the odds of CKD-stage III (odds ratio [OR] 3.10 [3.05-3.14], P < .0001) and modes increase for ESRD (OR 1.13 [1.09-1.18], P < .0001). Overall, even after adjusting for risk factors we observed that the rate of CKD is significantly higher in the control group, 12% when compared with 5.3% in the bariatric surgery group (P < .0001). CONCLUSION In this retrospective, case control study of a large, representative national sample of patients with severe obesity, BaS was found to be associated with significantly reduced point-prevalence and likelihood for CKD when adjusted for baseline CKD risk factors as compared with patients with obesity who did not undergo BaS. Overall, BaS resulted in a reduced rate and a moderate decrease in the likelihood of ESRD.
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Affiliation(s)
- David Romero Funes
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - David Gutierrez Blanco
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Liang Hong
- Department of Clinical Research, Cleveland Clinic Florida, Weston, Florida
| | - Emanuele Lo Menzo
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Samuel Szomstein
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida
| | - Raul J Rosenthal
- Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida.
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16
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Shikora SA, Edgerton C, Harris D, Buchwald H. Metabolic surgery. Curr Probl Surg 2021; 59:101059. [DOI: 10.1016/j.cpsurg.2021.101059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 09/03/2021] [Indexed: 11/29/2022]
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Song R, Nolan BJ, Harb H, Sumithran P. Intensive management of obesity in people with severe chronic kidney disease: A review. Diabetes Obes Metab 2021; 23:1733-1745. [PMID: 33904629 DOI: 10.1111/dom.14409] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/06/2021] [Accepted: 04/22/2021] [Indexed: 12/24/2022]
Abstract
Obesity is highly prevalent worldwide, including among people with chronic kidney disease (CKD). The presence of severe and/or end-stage kidney disease complicates the treatment of obesity for several reasons, including restrictions on protein and fluid intake and renal excretion of several medications indicated for the treatment of obesity. The aim of this review is to assess the safety of intensive obesity treatments, such as very-low-energy diets (VLEDs), obesity pharmacotherapy and/or bariatric surgery, in people with end-stage kidney disease. A literature search was conducted to identify studies reporting safety outcomes for VLEDs, liraglutide, phentermine, phentermine-topiramate, naltrexone-bupropion and bariatric surgery in people with an estimated glomerular filtration rate of less than 30 mL/min/1.73m2 or on dialysis. Limited data were insufficient to recommend VLEDs but highlighted their potential efficacy and the need for close clinical and biochemical monitoring. There were no data regarding centrally acting obesity pharmacotherapy in this population, although some glucagon-like peptide-1 analogues appear to safely induce weight loss at doses used for the treatment of type 2 diabetes. Some studies suggest an increased rate of complications of bariatric surgery in individuals with severe or end-stage CKD. Further prospective evaluation of intensive obesity management in the growing population with obesity and severe, end-stage and dialysis-dependent CKD is required.
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Affiliation(s)
- Richard Song
- Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Brendan J Nolan
- Department of Medicine (Austin), University of Melbourne, Melbourne, Victoria, Australia
- Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia
| | - Hecham Harb
- Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia
| | - Priya Sumithran
- Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia
- Department of Medicine (St Vincent's), University of Melbourne, Melbourne, Victoria, Australia
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18
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Palamuthusingam D, Singh A, Palamuthusingam P, Hawley CM, Pascoe EM, Johnson DW, Fahim M. Postoperative outcomes after bariatric surgery in patients on chronic dialysis: A systematic review and meta-analysis. Obes Res Clin Pract 2021; 15:473-484. [PMID: 34233859 DOI: 10.1016/j.orcp.2021.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 06/20/2021] [Accepted: 06/26/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Obesity is a barrier to kidney transplantation for patients with kidney failure. Consequently, bariatric surgery is often considered as a bridge to transplantation, even though its risks and benefits are poorly characterised in the dialysis population. METHODS Systematic searches of observational studies indexed in Embase, MEDLINE and CENTRAL till April 2020 were performed to identify relevant studies. Risk of bias was assessed by the Newcastle Ottawa Scale and quality of evidence was summarised in accordance with GRADE methodology. Random effects meta-analyses were performed to obtain summary odds ratios for postoperative outcomes. RESULTS Four cohort studies involving 4196 chronic dialysis and 732,204 non-dialysis patients undergoing bariatric surgery were included. Sleeve gastrectomy (61%), and Roux-en-Y gastric bypass (29%) were the most common procedures performed. Absolute rates of adverse events were low, but the odds of postoperative mortality (0.4-0.5% vs. 0.1%; odds ratio [OR] 4.7, 95%CI 2.2-9.9), and myocardial infarction (0.0-0.5% vs. 0.1%, OR 3.4, 95% CI 2.0-5.9) were higher in dialysis compared to non-dialysis patients. Patients on dialysis also had more than 2-fold increased odds of returning to theatre and having a readmission. Rates of kidney transplant wait-listing among dialysis patients was 59%, with 28% of all patients eventually receiving a kidney transplant. CONCLUSION Patients receiving chronic dialysis have substantially increased odds of postoperative mortality and myocardial infarction following bariatric surgery compared with patient who do not have kidney failure. It is uncertain whether bariatric surgery improves the likelihood of kidney transplantation, with mid- to long-term outcomes being poorly described.
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Affiliation(s)
- D Palamuthusingam
- Faculty of Medicine, University of Queensland, St Lucia, Queensland 4072, Australia; School of Medicine, Griffith University, Mount Gravatt, Queensland 4122, Australia.
| | - A Singh
- Department of Surgery, Townsville University Hospital, 100 Angus Smith Drive, Douglas, Queensland 4814, Australia.
| | - P Palamuthusingam
- Department of Surgery, Townsville University Hospital, 100 Angus Smith Drive, Douglas, Queensland 4814, Australia.
| | - C M Hawley
- Faculty of Medicine, University of Queensland, St Lucia, Queensland 4072, Australia; Metro South and Ipswich Nephrology and Transplant Services, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland 4102, Australia.
| | - E M Pascoe
- Centre for Health Services Research, University of Queensland, St Lucia, Queensland 4072, Australia.
| | - D W Johnson
- Faculty of Medicine, University of Queensland, St Lucia, Queensland 4072, Australia; Metro South and Ipswich Nephrology and Transplant Services, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland 4102, Australia; Translational Research Institute, Brisbane, Australia.
| | - M Fahim
- Faculty of Medicine, University of Queensland, St Lucia, Queensland 4072, Australia; Metro South and Ipswich Nephrology and Transplant Services, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland 4102, Australia; Metro North Health Service, Queensland Health, Butterfield Street, Herston, Queensland 4029, Australia.
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19
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Sheetz KH, Waits SA. Unravelling the Obesity Paradox Through Bariatric Surgery-Reply. JAMA Surg 2021; 155:1174-1175. [PMID: 32965469 DOI: 10.1001/jamasurg.2020.3793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Kyle H Sheetz
- Department of Surgery, University of Michigan, Ann Arbor.,Center for Healthcare Outcomes and Policy, Ann Arbor, Michigan
| | - Seth A Waits
- Department of Surgery, University of Michigan, Ann Arbor.,Center for Healthcare Outcomes and Policy, Ann Arbor, Michigan
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20
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Weight Loss After Bariatric Surgery in Morbidly Obese End-Stage Kidney Disease Patients as Preparation for Kidney Transplantation. Matched Pair Analysis in a High-Volume Bariatric and Transplant Center. Obes Surg 2021; 30:2708-2714. [PMID: 32249367 PMCID: PMC7260258 DOI: 10.1007/s11695-020-04555-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background The number of morbidly obese kidney transplant candidates is growing. They have limited access to kidney transplantation and are at a higher risk of postoperative complications. Bariatric surgery is considered as a safe weight loss method in those patients. Objectives Matched pair analysis was designed to analyze the preparatory and postoperative weight loss after bariatric procedures in end-stage kidney disease (ESKD) and non-ESKD morbidly obese patients. Methods Twenty patients with ESKD underwent bariatric surgery in our Centre of Excellence for Bariatric and Metabolic Surgery between 2015 and 2019 (nine one-anastomosis gastric bypasses, nine Roux-en-Y gastric bypasses, and two sleeve gastrectomies). They were compared with matched pairs from a dataset of 1199 morbidly obese patients without ESKD. Data on demographic factors and comorbidities was recorded. BMI was obtained at the start of the preparatory period preceding the bariatric procedure, at the time of procedure, and during the 1-year follow-up. Results The ESKD and non-ESKD patients did not differ significantly in preoperative weight loss (13.00 ± 11.69 kg and 15.22 ± 15.96 kg respectively, p = 0.619). During the 1-year follow-up, the weight loss was similar to the non-ESKD group. In the first 3 months, faster weight loss in ESKD was observed. Initial and follow-up BMI values did not differ significantly between groups. We demonstrated that obese patients with ESKD can lose weight as effectively as non-ESKD patients. Conclusion Morbidly obese ESKD patients have an equal weight loss to patients without ESKD. Bariatric surgery could improve access to kidney transplantation and may potentially improve transplantation outcomes of obese patients with ESKD.
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21
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Hajjar R, Lafrance JP, Tchervenkov J, Gingras S, Boutin L, Elftouh N, Andalib A, Pescarus R, Garneau PY, Chan G. Successful surgical weight loss with laparoscopic sleeve gastrectomy for morbid obesity prior to kidney transplantation. Transpl Int 2021; 34:964-973. [PMID: 33630394 DOI: 10.1111/tri.13855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/18/2021] [Accepted: 02/23/2021] [Indexed: 01/07/2023]
Abstract
Morbid obesity in kidney transplant (KT) candidates is associated with increased complications and graft failure. Multiple series have demonstrated rapid and significant weight loss after laparoscopic sleeve gastrectomy (LSG) in this population. Long-term and post-transplant weight evolutions are still largely unknown. A retrospective review was performed in eighty patients with end-stage kidney disease (ESKD) who underwent LSG in preparation for KT. From a median initial BMI of 43.7 kg/m2 , the median change at 1-year was -10.0 kg/m2 . Successful surgical weight loss (achieving a BMI < 35 kg/m2 or an excess body weight loss >50%) was attained in 76.3% and was associated with male gender, predialysis status, lower obesity class and lack of coronary artery disease. Thirty-one patients subsequently received a KT with a median delay of 16.7 months. Weight regain (increase in BMI of 5 kg/m2 postnadir) and recurrent obesity (weight regain + BMI > 35) remain a concern, occurring post-KT in 35.7% and 17.9%, respectively. Early LSG should be considered for morbidly obese patients with ESKD for improved weight loss outcomes. Early KT after LSG does not appear to affect short-term surgical weight loss. Candidates with a BMI of up to 45 kg/m2 can have a reasonable expectation to achieve the limit within 1 year.
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Affiliation(s)
- Roy Hajjar
- General Surgery Service, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, Canada.,Division of General Surgery, Department of Surgery, Université de Montréal, Montréal, QC, Canada
| | - Jean-Philippe Lafrance
- Nephrology Service, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, Canada.,Centre de Recherche de l'Hôpital Maisonneuve-Rosemont, Montréal, QC, Canada.,Département de Pharmacologie et Physiologie, Université de Montréal, Montréal, QC, Canada
| | - Jean Tchervenkov
- Department of Surgery, Royal Victoria Hospital, McGill University, Montréal, QC, Canada
| | - Sébastien Gingras
- General Surgery Service, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, Canada
| | - Lucie Boutin
- Nephrology Service, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, Canada
| | - Naoual Elftouh
- Nephrology Service, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, Canada
| | - Amin Andalib
- Department of Surgery, Centre for Bariatric Surgery, McGill University, Montréal, QC, Canada
| | - Radu Pescarus
- Hôpital Sacré-Cœur de Montréal, Université de Montréal, Montréal, QC, Canada
| | - Pierre Y Garneau
- Hôpital Sacré-Cœur de Montréal, Université de Montréal, Montréal, QC, Canada
| | - Gabriel Chan
- General Surgery Service, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, Canada.,Division of General Surgery, Department of Surgery, Université de Montréal, Montréal, QC, Canada
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22
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Sheetz KH, Gerhardinger L, Dimick JB, Waits SA. Bariatric Surgery and Long-term Survival in Patients With Obesity and End-stage Kidney Disease. JAMA Surg 2021; 155:581-588. [PMID: 32459318 DOI: 10.1001/jamasurg.2020.0829] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Obesity rates in patients with end-stage kidney disease are rising, contribute to excess morbidity, and limit access to kidney transplant. Despite this, there continues to be controversy around the use of bariatric surgery in this patient population. Objective To determine whether bariatric surgery is associated with improvement in long-term survival among patients with obesity and end-stage kidney disease. Design, Setting, and Participants Retrospective cohort study and secondary analysis of previously collected data from the United States Renal Data System registry (2006-2015). We used Cox proportional hazards analysis to evaluate differences in outcomes for patients receiving bariatric surgery (n = 1597) compared with a matched cohort of nonsurgical patients (n = 4750) receiving usual care. Data were analyzed between September 3, 2019, and November 13, 2019. Exposure Receipt of bariatric surgery. Main Outcomes and Measures All-cause mortality at 5 years. Secondary outcomes included disease-specific mortality and incidence of kidney transplant. Results Surgical and nonsurgical control patients had similar age, demographics, and comorbid disease burden. The mean (SD) age was 49.8 (11.2) years for surgical patients vs 51.7 (11.1) years for nonsurgical patients. Six hundred fifteen surgical patients (38.5%) were black vs 1833 nonsurgical patients (38.6%). Surgery was associated with lower all-cause mortality at 5 years compared with usual care (cumulative incidence, 25.6% vs 39.8%; hazard ratio, 0.69, 95% CI, 0.60-0.78). This was driven by lower mortality from cardiovascular causes at 5 years for patients undergoing bariatric surgery compared with nonsurgical control patients (cumulative incidence, 8.4% vs 17.2%; hazard ratio, 0.51; 95% CI, 0.41-0.65). Bariatric surgery was also associated with an increase in kidney transplant at 5 years (cumulative incidence, 33.0% vs 20.4%; hazard ratio, 1.82; 95% CI, 1.58-2.09). However, at 1 year, bariatric surgery was associated with higher all-cause mortality compared with usual care (cumulative incidence, 8.6% vs 7.7%; hazard ratio, 1.45; 95% CI, 1.13-1.85). Conclusions and Relevance Among patients with obesity and end-stage kidney disease, bariatric surgery was associated with lower all-cause mortality compared with usual care. Bariatric surgery was also associated with an increase in kidney transplant. Bariatric surgery may warrant further consideration in the treatment of patients with obesity and end-stage kidney disease.
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Affiliation(s)
- Kyle H Sheetz
- Department of Surgery, University of Michigan, Ann Arbor.,Center for Healthcare Outcomes and Policy, Ann Arbor, Michigan
| | | | - Justin B Dimick
- Department of Surgery, University of Michigan, Ann Arbor.,Center for Healthcare Outcomes and Policy, Ann Arbor, Michigan
| | - Seth A Waits
- Department of Surgery, University of Michigan, Ann Arbor.,Center for Healthcare Outcomes and Policy, Ann Arbor, Michigan
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23
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Huang X, Li G, Xu B, Zhang J, Wang X, Cheng X, Jayachandran M, Huang Y, Qu S. Lower Baseline Serum Triglyceride Levels Are Associated With Higher Decrease in Body Mass Index After Laparoscopy Sleeve Gastrectomy Among Obese Patients. Front Endocrinol (Lausanne) 2021; 12:633856. [PMID: 33692759 PMCID: PMC7937917 DOI: 10.3389/fendo.2021.633856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/07/2021] [Indexed: 12/23/2022] Open
Abstract
AIMS To investigate the predictive value of baseline serum triglyceride (TG) levels for improvements of metabolism after laparoscopic sleeve gastrectomy (LSG). METHODS 112 obese patients [body mass index (BMI) ≥ 35 kg/m2] underwent LSG and with complete information of anthropometric and metabolic parameters were divided into normal TG group (group A) and high TG group (group B), while group A had TG levels ≤ 1.7 mmol/L, and group B had TG levels > 1.7 mmol/L. The post-operative changes (Δ) in metabolic parameters between the two groups were compared. RESULTS In the whole cohort, the metabolic parameters were significantly improved at 6 months after LSG. BMI and waist circumference (WC) decreased significantly in the two groups. The ΔBMI among group A and group B were 11.42±3.23 vs 9.13±2.77 kg/m2 (p<0.001), respectively. ΔBMI was positively correlated with ΔWC (r=0.696, p<0.001), Δfasting insulin level (r=0.440, p=0.002), Δfasting serum C peptide level (r=0.453, p=0.002), and Δhomeostasis model assessment insulin resistance index (r=0.418, p=0.004) in group A. Compared with group B, group A had a significantly higher odds ratio (OR) of 2.83 (95% confidence interval [CI]1.25-6.38, p=0.012)and 2.73 (95% CI 1.11-6.72, p=0.029) for ΔBMI and ΔWC after adjustment for age and gender, respectively. CONCLUSIONS Obese patients with baseline TG levels under 1.7 mmol/L had greater loss of weight at six months follow-up later LSG. This finding suggests that baseline TG level may have a predictive value for weight loss, at least in the short-term follow-up.
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Affiliation(s)
- Xiu Huang
- Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, School of Medicine Tongji University, Shanghai, China
| | - Guifang Li
- Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, School of Medicine Tongji University, Shanghai, China
| | - Bei Xu
- Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, School of Medicine Tongji University, Shanghai, China
| | - Junyi Zhang
- Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, School of Medicine Tongji University, Shanghai, China
| | - Xingchun Wang
- Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, School of Medicine Tongji University, Shanghai, China
- Shanghai Center of Thyroid Disease, Shanghai, China
| | - Xiaoyun Cheng
- Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, School of Medicine Tongji University, Shanghai, China
| | - Muthukumaran Jayachandran
- Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, School of Medicine Tongji University, Shanghai, China
| | - Yueye Huang
- Shanghai Center of Thyroid Disease, Shanghai, China
- *Correspondence: Shen Qu, ; Yueye Huang,
| | - Shen Qu
- Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, School of Medicine Tongji University, Shanghai, China
- Shanghai Center of Thyroid Disease, Shanghai, China
- *Correspondence: Shen Qu, ; Yueye Huang,
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24
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Chintam K, Chang AR. Strategies to Treat Obesity in Patients With CKD. Am J Kidney Dis 2020; 77:427-439. [PMID: 33075388 DOI: 10.1053/j.ajkd.2020.08.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/11/2020] [Indexed: 12/17/2022]
Abstract
Obesity prevalence continues to increase worldwide, accompanied by a rising tide of hypertension, diabetes, and chronic kidney disease (CKD). Although body mass index is typically used to assess obesity in clinical practice, altered body composition (eg, reduced muscle mass and increased visceral adiposity) are common among patients with CKD. Weight loss achieved through behavioral modification or medications reduces albuminuria and in some cases slows the decline in estimated glomerular filtration rate. Use of medications that promote weight loss with favorable cardiovascular risk profiles should be promoted, particularly in patients with type 2 diabetes, obesity, and CKD. For those who fail to achieve weight loss through lifestyle modification, bariatric surgery should be considered because observational studies have shown reductions in risk for estimated glomerular filtration rate decline and kidney failure. Uncertainty persists on the risk to benefit ratio of intentional weight loss in patients with kidney failure due to the lack of prospective trials and limitations of observational data. Regardless, sleeve gastrectomy is increasingly being used for patients with kidney failure and severe obesity, with success in achieving sustained weight loss, improved access to kidney transplantation, and favorable posttransplantation outcomes. More research is needed assessing long-term cardiovascular and kidney outcomes of most weight loss medications.
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Affiliation(s)
| | - Alex R Chang
- Department of Population of Health Sciences, Geisinger, Danville, PA; Kidney Health Research Institute, Geisinger, Danville, PA; Department of Nephrology, Geisinger, Danville, PA.
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25
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Docherty NG, le Roux CW. Bariatric surgery for the treatment of chronic kidney disease in obesity and type 2 diabetes mellitus. Nat Rev Nephrol 2020; 16:709-720. [DOI: 10.1038/s41581-020-0323-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2020] [Indexed: 12/13/2022]
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26
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Diwan TS, Lee TC, Nagai S, Benedetti E, Posselt A, Bumgardner G, Noria S, Whitson BA, Ratner L, Mason D, Friedman J, Woodside KJ, Heimbach J. Obesity, transplantation, and bariatric surgery: An evolving solution for a growing epidemic. Am J Transplant 2020; 20:2143-2155. [PMID: 31965711 DOI: 10.1111/ajt.15784] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 01/05/2020] [Accepted: 01/08/2020] [Indexed: 01/25/2023]
Abstract
The increasing obesity epidemic has major implications in the realm of transplantation. Patients with obesity face barriers in access to transplant and unique challenges in perioperative and postoperative outcomes. Because of comorbidities associated with obesity, along with the underlying end-stage organ disease leading to transplant candidacy, these patients may not even be referred for transplant evaluation, much less be waitlisted or actually undergo transplant. However, the use of bariatric surgery in this population can help optimize the transplant candidacy of patients with obesity and end-stage organ disease and improve perioperative and postoperative outcomes. We review the impact of obesity on kidney, liver, and cardiothoracic transplant candidates and recipients and explore potential interventions to address obesity in these populations.
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Affiliation(s)
| | | | | | | | - Andrew Posselt
- University of California at San Francisco, San Francisco, California, USA
| | | | | | | | - Lloyd Ratner
- Columbia University Medical Center, New York, New York, USA
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27
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Diwan TS, Cuffy MC, Linares-Cervantes I, Govil A. Impact of obesity on dialysis and transplant and its management. Semin Dial 2020; 33:279-285. [PMID: 32277512 DOI: 10.1111/sdi.12876] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Obesity is increasing to unprecedented levels, including in the end-stage kidney disease population, where upwards of 60% of kidney transplant patients are overweight or obese. Obesity poses additional challenges to the care of the dialysis patient, including difficulties in creating vascular access and inserting Tenckhoff catheters, higher rates of catheter malfunction and peritonitis, the need for longer and/or more frequent dialysis (or peritoneal dialysis [PD] exchanges) to achieve adequate clearance, increased metabolic complications particularly with PD, and obesity is a barrier to kidney transplantation. In this article, we review special considerations in performing PD, hemodialysis and transplant in the obese patient, as well as the evidence behind medical and surgical management of obesity in dialysis patients.
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Affiliation(s)
- Tayyab S Diwan
- Division of Transplantation, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Madison C Cuffy
- Division of Transplantation, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Ivan Linares-Cervantes
- Division of Transplantation, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Amit Govil
- Division of Nephrology, Department of Medicine, University of Cincinnati, Cincinnati, OH, USA
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28
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Suresh A, Robinson L, Milliron BJ, Leonberg K, McAdams-DeMarco M, Earthman C, Klassen A, Harhay MN. Approaches to Obesity Management in Dialysis Settings: Renal Dietitian Perspectives. J Ren Nutr 2020; 30:561-566. [PMID: 32144072 DOI: 10.1053/j.jrn.2020.01.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 01/15/2020] [Accepted: 01/20/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Over 40% of individuals in the United States with end-stage kidney disease have obesity. Little is known about renal dietitian perspectives on obesity management in the setting of dialysis dependence. DESIGN AND METHODS An online 21-item survey was distributed to 118 renal dietitians via individual outreach and a professional organization e-mail listserv. Four themes were explored: the burden of obesity among dialysis patients, concepts of healthy weight loss, weight loss approaches, and challenges of obesity management in dialysis settings. Respondents were asked to rank approaches and biomarkers for obesity management from 0 (least important or not used) to 100 (most important). Free text fields were provided in each category for additional comments. RESULTS Thirty-one renal dietitians responded to the survey (26% response rate). The majority of respondents (90%) indicated that access to kidney transplantation was the main reason that dialysis patients with obesity desired weight loss. Calorie restriction was rated as the most common weight loss approach, and dry weight as the most important weight loss biomarker. Nearly 40% of respondents do not alter their nutritional approach when dialysis patients with obesity are losing weight, and 42% of respondents do not monitor changes in waist circumference. Exercise, diet counseling, and stress management were variably prioritized as weight loss management strategies. Barriers to obesity management in dialysis settings included lack of time, lack of training in weight loss counseling, and gaps in current renal nutritional guidelines. CONCLUSION Despite the high prevalence of obesity among individuals with end-stage kidney disease, the results of this survey suggest that current approaches to obesity management in dialysis settings are highly variable. Many renal dietitians lack time to counsel patients on healthy weight loss strategies. Nutritional guidelines are also needed to support people with dialysis dependence and obesity who desire or require weight loss.
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Affiliation(s)
- Aditi Suresh
- Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Lucy Robinson
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Brandy-Joe Milliron
- Department of Nutrition Sciences and Center for Family Intervention, Drexel University College of Nursing and Health Professions, Philadelphia, Pennsylvania
| | | | - Mara McAdams-DeMarco
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Carrie Earthman
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, Delaware
| | - Ann Klassen
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Meera N Harhay
- Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania; Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania; Tower Health Transplant Institute, Tower Health System, West Reading, Pennsylvania.
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29
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Martin WP, White J, López-Hernández FJ, Docherty NG, le Roux CW. Metabolic Surgery to Treat Obesity in Diabetic Kidney Disease, Chronic Kidney Disease, and End-Stage Kidney Disease; What Are the Unanswered Questions? Front Endocrinol (Lausanne) 2020; 11:289. [PMID: 33013677 PMCID: PMC7462008 DOI: 10.3389/fendo.2020.00289] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 04/17/2020] [Indexed: 12/11/2022] Open
Abstract
Obesity is a major factor in contemporary clinical practice in nephrology. Obesity accelerates the progression of both diabetic and non-diabetic chronic kidney disease and, in renal transplantation, both recipient and donor obesity increase the risk of allograft complications. Obesity is thus a major driver of renal disease progression and a barrier to deceased and living donor kidney transplantation. Large observational studies have highlighted that metabolic surgery reduces the incidence of albuminuria, slows chronic kidney disease progression, and reduces the incidence of end-stage kidney disease over extended follow-up in people with and without type 2 diabetes. The surgical treatment of obesity and its metabolic sequelae has therefore the potential to improve management of diabetic and non-diabetic chronic kidney disease and aid in the slowing of renal decline toward end-stage kidney disease. In the context of patients with end-stage kidney disease, although complications of metabolic surgery are higher, absolute event rates are low and it remains a safe intervention in this population. Pre-transplant metabolic surgery increases access to kidney transplantation in people with obesity and end-stage kidney disease. Metabolic surgery also improves management of metabolic complications post-kidney transplantation, including new-onset diabetes. Procedure selection may be critical to mitigate the risks of oxalate nephropathy and disruption to immunosuppressant pharmacokinetics. Metabolic surgery may also have a role in the treatment of donor obesity, which could increase the living kidney donor pool with potential downstream impact on kidney paired exchange programmes. The present paper provides a comprehensive coverage of the literature concerning renal outcomes in clinical studies of metabolic surgery and integrates findings from relevant mechanistic pre-clinical studies. In so doing the key unanswered questions for the field are brought to the fore for discussion.
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Affiliation(s)
- William P. Martin
- Diabetes Complications Research Centre, School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
- *Correspondence: William P. Martin
| | - James White
- Diabetes Complications Research Centre, School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
| | - Francisco J. López-Hernández
- Instituto de Estudios de Ciencias de la Salud de Castilla y León-Instituto de Investigación Biomédica de Salamanca (IECSCYL-IBSAL), Hospital Virgen Vega, Salamanca, Spain
| | - Neil G. Docherty
- Diabetes Complications Research Centre, School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
| | - Carel W. le Roux
- Diabetes Complications Research Centre, School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
- Division of Investigative Science, Imperial College London, London, United Kingdom
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30
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Montgomery JR, Ghaferi AA, Waits SA. Bariatric surgery among patients with end-stage kidney disease: improving access to transplantation. Surg Obes Relat Dis 2020; 16:14-16. [DOI: 10.1016/j.soard.2019.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 10/03/2019] [Indexed: 01/24/2023]
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31
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Affiliation(s)
- Claire Kennedy
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Joanne Bargman
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
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32
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Erickson KF, Navaneethan SD. Bariatric Surgery for ESKD Patients: Why, When, and How? Clin J Am Soc Nephrol 2019; 14:1125-1127. [PMID: 31345841 PMCID: PMC6682812 DOI: 10.2215/cjn.07350619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Kevin F Erickson
- Selzman Institute for Kidney Health, Section of Nephrology and .,Center for Innovations in Quality, Effectiveness, and Safety, Baylor College of Medicine, Houston, Texas.,Baker Institute for Public Policy, Rice University, Houston, Texas; and
| | - Sankar D Navaneethan
- Selzman Institute for Kidney Health, Section of Nephrology and.,Section of Nephrology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
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