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Mallappallil M, Sasidharan S, Sabu J, John S. Treatment of Type 2 Diabetes Mellitus in Advanced Chronic Kidney Disease for the Primary Care Physician. Cureus 2024; 16:e64663. [PMID: 39149651 PMCID: PMC11326530 DOI: 10.7759/cureus.64663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2024] [Indexed: 08/17/2024] Open
Abstract
Diabetes mellitus (DM) is a common cause of chronic kidney disease (CKD), leading to the need for renal replacement therapy (RRT). RRT includes hemodialysis (HD), peritoneal dialysis (PD), kidney transplantation (KT), and medical management. As CKD advances, the management of DM may change as medication clearance, effectiveness, and side effects can be altered due to decreasing renal clearance. Medications like metformin that were safe to use early in CKD may build up toxic levels of metabolites in advanced CKD. Other medications, like sodium-glucose co-transporter 2 inhibitors, which work by excreting glucose in the urine, may not be able to work effectively in advanced CKD due to fewer working nephrons. Insulin breakdown may take longer, and both formulation and dosing may need to be changed to avoid hypoglycemia. While DM control contributes to CKD progression, effective DM control continues to be important even after patients have been placed on RRT. Patients on RRT are frequently taken care of by a team of providers, including the primary care physician, both in and outside the hospital. Non-nephrologists who are involved with the care of a patient treated with RRT need to be adept at managing DM in this population. This paper aims to outline the management of type 2 DM in advanced CKD.
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Affiliation(s)
- Mary Mallappallil
- Internal Medicine and Nephrology, New York City (NYC) Health + Hospitals/Kings County Hospital Center, Brooklyn, USA
- Internal Medicine and Nephrology, State University of New York (SUNY) Downstate University of Health Sciences, Brooklyn, USA
| | - Sandeep Sasidharan
- Internal Medicine and Nephrology, State University of New York (SUNY) Downstate University of Health Sciences, Brooklyn, USA
- Internal Medicine and Nephrology, New York City (NYC) Health + Hospitals/Kings County Hospital Center, Brooklyn, USA
| | - Jacob Sabu
- Internal Medicine, State University of New York (SUNY) Downstate Health Sciences University, Brooklyn, USA
| | - Sabu John
- Internal Medicine and Cardiology, New York City (NYC) Health + Hospitals/Kings County Hospital Center, Brooklyn, USA
- Internal Medicine and Cardiology, State University of New York (SUNY) Downstate University of Health Sciences, Brooklyn, USA
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2
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Spaggiari M, Martinino A, Bencini G, Masrur MA, Petrochenkov E, Lian A, Olazar J, Di Cocco P, Almario-Alvarez J, Benedetti E, Tzvetanov I. Timing Considerations for Sleeve Gastrectomy in Kidney Transplant Patients: A Single Center Evaluation. Transpl Int 2024; 37:12690. [PMID: 38957660 PMCID: PMC11217181 DOI: 10.3389/ti.2024.12690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 06/07/2024] [Indexed: 07/04/2024]
Abstract
Current scientific literature is deficient in detailing the optimal timing for conducting bariatric surgery in relation to kidney transplantation. In this study, we performed a retrospective evaluation of kidney transplant recipients with BMI >35 kg/m2. It aimed to provide data on those who received both sleeve gastrectomy (SG) and kidney transplantation (KT) simultaneously, as well as on patients who underwent SG and KT at different times, either before or after. In addition, the acceptance levels of the bariatric surgery among different scenarios were assessed. Our findings demonstrated that combined KT and SG led to successful weight loss, in contrast to undergoing kidney transplant alone, while maintaining comparable rates of graft and patient survival. Weight loss was similar between recipients who had a combined operation and those who underwent SG following the transplant. Additionally, over a median time frame of 1.7 years, patients who underwent SG before KT exhibited a statistically significant reduction in BMI at the time of the transplant. Notably, our study highlights that patients offered the combined procedure were significantly more likely to undergo SG compared to those for whom SG was presented at a different operative time than the transplant.
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Affiliation(s)
- Mario Spaggiari
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL, United States
| | - Alessandro Martinino
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL, United States
| | - Giulia Bencini
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL, United States
| | - Mario A. Masrur
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL, United States
| | - Egor Petrochenkov
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL, United States
| | - Amy Lian
- University of Illinois at Chicago College of Medicine, Chicago, IL, United States
| | - Joanna Olazar
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL, United States
| | - Pierpaolo Di Cocco
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL, United States
| | - Jorge Almario-Alvarez
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL, United States
| | - Enrico Benedetti
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL, United States
| | - Ivo Tzvetanov
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL, United States
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Noya-Mourullo A, Martín-Parada A, Palacios-Hernández A, Eguiluz-Lumbreras P, Heredero-Zorzo Ó, García-Gómez F, Álvarez-Ossorio-Fernández JL, Álvarez-Ossorio-Rodal A, Márquez-Sánchez MT, Flores-Fraile J, Fraile-Gómez P, Padilla-Fernández BY, Lorenzo-Gómez MF. Enhancing Kidney Transplant Outcomes: The Impact of Living Donor Programs. J Pers Med 2024; 14:408. [PMID: 38673035 PMCID: PMC11051259 DOI: 10.3390/jpm14040408] [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: 03/10/2024] [Revised: 04/03/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION The protocol for deceased donor kidney transplants has been standardised. The procedure for a living donor has peculiarities derived from the differences in the graft. When a living kidney donor program is implemented, changes occur in both the profile of the kidney transplant candidate and in the postoperative treatments. AIMS To discover whether a living donor program influences the functional outcomes of kidney grafts in a longstanding classical deceased donor kidney transplant program and to identify the factors associated with transplant outcomes. METHODS Retrospective observational multicentre study. SAMPLE Kidney transplant patients in two urology referral centres for renal transplant in Spain between 1994 and 2019. Groups: TV (living transplant): patients given kidney transplants from living donors (n = 150); TCpre11 (deceased transplant previous to 2011): patients given kidney transplants from deceased donors before the living donor program was implemented (n = 650); and TCpost11 (deceased transplant after 2011): patients given kidney transplants from deceased donors after the living donor program was implemented (n = 500). RESULTS Mean age was 55.75 years (18-80 years), higher in TCpre11. There were 493 female patients (37.92%) and 1007 male patients (62.08%). Mean body mass index (BMI) was 26.69 kg/m2 (17.50-42.78 kg/m2), higher in TCpre11. Mean ischemia time was 17.97 h (6-29 h), higher in TCpost11. Median duration of urethral catheter: 8 days (6-98 days), higher in TCpost11. Median duration of double-J ureteral stent: 58 days (24-180 days), higher in TCpost11. Pretransplant UTIs: 17.77%, higher in TCpre11 (25.69%) than in TV (12%), higher in TV (12%) than TCpost11 (9.2%), and higher in TCpre11 (25.69%) than TCpost11 (9.2%). Acute renal rejection in 9.33% of TV, 14.77% of TCpre11, and 9.8% of TCpost11. Multivariate analysis: TCpost11 featured higher BMI, more smoking, and chronic renal failure progression time. Lower use of nonantibiotic prophylaxis to prevent recurrent urinary tract infections, increased duration of urethral catheters due to obstructive problems, and favoured deterioration of kidney function was observed in the deceased donor program. The living donor (LD) program had a strong influence on deceased donor transplants in the prelysis phase. Implementation of a LD program was associated with a decrease in the likelihood of acute rejection in TCpost11 and an increase in the tendency towards normal kidney function. CONCLUSIONS Implementing living donor transplant programs affects functional outcomes in deceased donor transplants, reducing the probability of acute rejection and increasing the tendency towards normal kidney function. Preventing recurrent urinary tract infections with measures other than antibiotics, smoking cessation, delaying the removal of the double-J stent from the graft, and pre-emptive transplant (transplant prior to dialysis) are associated with improved renal function of the graft.
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Affiliation(s)
- Andrea Noya-Mourullo
- Urology Department, University Hospital of Salamanca, 37007 Salamanca, Spain; (A.N.-M.); (Ó.H.-Z.); (F.G.-G.)
- Department of Surgery, University of Salamanca, 37007 Salamanca, Spain (M.-T.M.-S.)
| | - Alejandro Martín-Parada
- Urology Department, University Hospital of Salamanca, 37007 Salamanca, Spain; (A.N.-M.); (Ó.H.-Z.); (F.G.-G.)
| | - Alberto Palacios-Hernández
- Urology Department, University Hospital of Salamanca, 37007 Salamanca, Spain; (A.N.-M.); (Ó.H.-Z.); (F.G.-G.)
| | - Pablo Eguiluz-Lumbreras
- Urology Department, University Hospital of Salamanca, 37007 Salamanca, Spain; (A.N.-M.); (Ó.H.-Z.); (F.G.-G.)
| | - Óscar Heredero-Zorzo
- Urology Department, University Hospital of Salamanca, 37007 Salamanca, Spain; (A.N.-M.); (Ó.H.-Z.); (F.G.-G.)
| | - Francisco García-Gómez
- Urology Department, University Hospital of Salamanca, 37007 Salamanca, Spain; (A.N.-M.); (Ó.H.-Z.); (F.G.-G.)
| | | | | | | | - Javier Flores-Fraile
- Department of Surgery, University of Salamanca, 37007 Salamanca, Spain (M.-T.M.-S.)
| | - Pilar Fraile-Gómez
- Nephrology Department, University Hospital of Salamanca, 37007 Salamanca, Spain;
| | | | - María-Fernanda Lorenzo-Gómez
- Urology Department, University Hospital of Salamanca, 37007 Salamanca, Spain; (A.N.-M.); (Ó.H.-Z.); (F.G.-G.)
- Department of Surgery, University of Salamanca, 37007 Salamanca, Spain (M.-T.M.-S.)
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Tish S, Corcelles R. The Art of Sleeve Gastrectomy. J Clin Med 2024; 13:1954. [PMID: 38610719 PMCID: PMC11012326 DOI: 10.3390/jcm13071954] [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: 02/16/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
Sleeve gastrectomy (SG) has historically evolved from gastroplasty and anti-reflux procedures into one of the most commonly performed primary metabolic surgeries in the United States and worldwide. Initially initiated in the 1980s as part of the duodenal switch procedure, its standalone effectiveness and simplicity have led to increasing popularity globally. The rise in obesity rates transcends age boundaries, alarmingly affecting not only adults but also the younger demographic. This escalating trend is concerning, as it predisposes these populations to numerous future health complications, as well as highlighting the critical necessity for a safe and potent weight loss strategy. Although sleeve gastrectomy carries a higher risk for gastroesophageal reflux disease (GERD) compared to other bariatric procedures, it stands out as a reliable, safe and effective surgical solution for obesity. It is particularly beneficial for adolescents and patients with complex medical comorbidities, including, but not limited to, heart failure and immunocompromisation. It has also served as a bridge for transplants in morbidly obese patients with end-stage heart, liver and kidney disease due to its favorable safety profile.
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Affiliation(s)
- Shahed Tish
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH 44195, USA;
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Smith L. Making the Transplant List: When Weight Weighs In. KIDNEY360 2023; 4:1770-1771. [PMID: 38153792 PMCID: PMC10917114 DOI: 10.34067/kid.0000000000000295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
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6
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Sarno G, Frias-Toral E, Ceriani F, Montalván M, Quintero B, Suárez R, García Velasquèz E, Muscogiuri G, Iannelli A, Pilone V, Schiavo L. The Impact and Effectiveness of Weight Loss on Kidney Transplant Outcomes: A Narrative Review. Nutrients 2023; 15:nu15112508. [PMID: 37299471 DOI: 10.3390/nu15112508] [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: 04/15/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
Obesity is a worldwide epidemic that leads to several non-communicable illnesses, including chronic kidney disease (CKD). Diet and lifestyle modifications have shown a limited impact in the treatment of obesity. Because the group of end-stage renal disease (ESRD) patients examined in this study had limited access to kidney transplantation (KT), patients with obesity were thought to be at an increased risk of intraoperative and postoperative KT complications. Although bariatric surgery (BS) is now recognized as the gold standard treatment for morbid obesity, its role in ESRD or kidney transplant patients remains unknown. It is critical to know the correlation between weight loss and complications before and after KT, the impact of the overall graft, and patients' survival. Hence, this narrative review aims to present updated reports addressing when to perform surgery (before or after a KT), which surgical procedure to perform, and again, if strategies to avoid weight regain must be specific for these patients. It also analyzes the metabolic alterations produced by BS and studies its cost-effectiveness pre- and post-transplantation. Due to the better outcomes found in KT recipients, the authors consider it more convenient to perform BS before KT. However, more multicenter trials are required to provide a solid foundation for these recommendations in ERSD patients with obesity.
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Affiliation(s)
- Gerardo Sarno
- San Giovanni di Dio e Ruggi D'Aragona, University Hospital, Scuola Medica Salernitana, 84131 Salerno, Italy
| | - Evelyn Frias-Toral
- School of Medicine, Universidad Espìritu Santo, Samborondòn 091952, Ecuador
| | - Florencia Ceriani
- Nutrition School, Universidad de la República (UdelaR), Ricaldoni s/n, Montevideo 11300, Uruguay
| | - Martha Montalván
- School of Medicine, Universidad Catòlica Santiago de Guayaquil, Av. Pdte. Carlos Julio Arosemena Tola, Guayaquil 090615, Ecuador
| | - Beatriz Quintero
- School of Medicine, Universidad Técnica Particular de Loja, Calle París, San Cayetano Alto, Loja 110101, Ecuador
| | - Rosario Suárez
- School of Medicine, Universidad Técnica Particular de Loja, Calle París, San Cayetano Alto, Loja 110101, Ecuador
| | | | - Giovanna Muscogiuri
- Endocrinology Unit, Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy
| | - Antonio Iannelli
- Department of Clinical Research and Innovation, University Hospital of Nice, Cimiez Hospital, 06000 Nice, France
- Digestive Surgery and Liver Transplantation Unit, University Hospital of Nice, Archet 2 Hospital, 06200 Nice, France
- Inserm, U1065, Team 8 "Hepatic Complications of Obesity and Alcohol", 06204 Nice, France
| | - Vincenzo Pilone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Baronissi, Italy
| | - Luigi Schiavo
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Baronissi, Italy
- National Biodiversiy Future Center, 90133 Palermo, Italy
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7
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A 5-year propensity-matched analysis of perioperative outcomes in patients with chronic kidney disease undergoing bariatric surgery. Surg Endosc 2023; 37:2335-2346. [PMID: 36401102 DOI: 10.1007/s00464-022-09756-z] [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: 06/13/2022] [Accepted: 11/01/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Bariatric surgery can improve renal function in patients with comorbid chronic kidney disease (CKD) and obesity. Additionally, bariatric surgery can enhance outcomes following renal transplantation. The safety of bariatric surgery in patients with CKD has been debated in the literature. This study evaluates the frequency of perioperative complications associated with CKD. METHODS The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database was queried from 2015-2019. Patients were included if they had a vertical sleeve gastrectomy (VSG) or Roux-en-Y gastric bypass (RYGB) and were stratified based on CKD status. An unmatched and propensity-matched analysis was performed comparing 30-day perioperative outcomes between the groups. RESULTS A total of 717,809 patients included in this study, 5817(0.8%) had CKD, of whom 2266(0.3%) were on dialysis. 74.3% of patients with CKD underwent VSG with 25.7% underwent RYGB. Comparing RYGB to VSG, patients who underwent RYGB had a higher rate of deep organ space infection (0.7%vs.0.1%,p = 0.021) and re-intervention (5.0% vs. 2.2%,p < 0.001). Within the VSG cohort, a matched analysis was performed for those with CKD and without CKD. The CKD cohort had higher risk of complications such as bleeding (2.1%vs. 0.9%,p < 0.001), readmission (9.3%vs.4.9%,p < 0.001), reoperation (2.7%vs.1.3%,p < 0.001), and need for reintervention (2.2%vs.1.3%,p < 0.001). Notably, patients with CKD also had a higher mortality (0.6%vs.0.2%,p = 0.003). No difference was seen between patients with renal insufficiency and patients on dialysis. CONCLUSION VSG has been the operation of choice in patients with CKD. Our results showed it is the safer option for patients with CKD compared to RYGB. Although this patient population does have an increased risk of adverse perioperative events, dialysis didn't affect the outcome. Bariatric surgeons who operate on patients with CKD should be well informed and remain vigilant given the increased perioperative risk. The risk is still considerably low, and the potential benefit on renal function and improvement in candidacy for renal transplant outweigh the risk. They should be considered as surgical candidates.
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8
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Barry JM. Invited Commentary: Kidney Transplantation and Obesity: Are There Any Differences in Outcomes? World J Surg 2023; 47:519. [PMID: 36376591 DOI: 10.1007/s00268-022-06831-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 11/16/2022]
Affiliation(s)
- John M Barry
- Departments of Surgery and Urology, Oregon Health & Science University, 3303 S. Bond Ave., Portland, OR, 97236, USA.
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9
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Outcomes of kidney transplant recipients who underwent pre-transplant bariatric surgery for severe obesity: a long-term follow-up study. Surg Endosc 2023; 37:494-502. [PMID: 36002684 PMCID: PMC9401197 DOI: 10.1007/s00464-022-09552-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/08/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Kidney transplantation (KT) is the preferred therapy for end-stage renal disease (ESRD). While a major cause for ESRD, obesity is also a key obstacle to candidacy for KT. Bariatric surgery, particularly sleeve gastrectomy (SG), is increasingly used to improve access to KT in patients with obesity, but the literature especially on outcomes post-KT remains lacking. We aimed to provide a long-term follow-up analysis of efficacy and outcomes of a previously described cohort of patients with obesity, who had SG as a means for access to KT. METHODS This is a single-center retrospective follow-up study of 32 patients with advanced chronic kidney disease or ESRD, who were referred and underwent SG between 2013 and 2018 as an access strategy to KT. The primary outcome was successful KT. Ninety-day outcomes, long-term graft function, and changes in weight and obesity-related comorbidities after KT were assessed. Descriptive statistics are presented as count (percentage) or median (interquartile range). RESULTS At baseline, 18 (56%) were male with a median age and BMI of 51 (11) years and 42.3 (5.2) kg/m2, respectively. Median follow-up time post-SG was 53 (58) months. At last follow-up, 23 (72%) patients received KT. Median time to KT was 16 (20) months and BMI was 34.0 (5.1) kg/m2 at time of transplant. At KT, 13 (57%) and 20 (87%) had diabetes and hypertension, respectively. Median follow-up post-KT was 16 (47) months. There was one graft loss requiring return to dialysis. At 5-year post-KT, median serum creatinine was 136 (66) µmol/l. At last follow-up post-KT, median BMI remained at 33.7 (7.6) kg/m2. Among patients with diabetes and hypertension, 7/13 (54%) and 5/20 (25%) had either improvement or remission of their comorbidities, respectively. CONCLUSION SG is an effective strategy to improve access to KT in patients with severe obesity. Transplant recipients also continue to benefit from sustained weight loss and improved related comorbidities that may positively impact their graft function after KT.
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10
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Ardiles LG. Obesity and renal disease: Benefits of bariatric surgery. Front Med (Lausanne) 2023; 10:1134644. [PMID: 36926320 PMCID: PMC10011092 DOI: 10.3389/fmed.2023.1134644] [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: 12/30/2022] [Accepted: 01/25/2023] [Indexed: 03/04/2023] Open
Abstract
The prevalence of obesity, a preventable and reversible condition with a high impact on health, continues to rise, especially after the COVID-19 pandemic. Severe overweight is well recognized as a risk factor for diabetes and hypertension, among other conditions, that may increase cardiovascular risk. Obesity has grown simultaneously with a rise in the prevalence of chronic kidney disease, and a pathophysiological link has been established, which explains its role in generating the conditions to facilitate the emergence and maximize the impact of the risk factors of chronic kidney disease and its progression to more advanced stages. Knowing the mechanisms involved and having different tools to reverse the overweight and its consequences, bariatric surgery has arisen as a useful and efficient method, complementary or alternative to others, such as lifestyle changes and/or pharmacotherapy. In a detailed review, the mechanisms involved in the renal consequences of obesity, the impact on risk factors, and the potential benefit of bariatric surgery at different stages of the disease and its progression are exposed and analyzed. Although the observational evidence supports the value of bariatric surgery as a renoprotective measure in individuals with obesity, diabetic or not, randomized studies are expected to establish evidence-based recommendations that demonstrate its positive risk-benefit balance as a complementary or alternative therapeutic tool.
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Affiliation(s)
- Leopoldo G Ardiles
- Department of Nephrology, Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile
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11
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Bariatric Surgery Outcomes in Patients with Kidney Transplantation. J Clin Med 2022; 11:jcm11206030. [PMID: 36294351 PMCID: PMC9604744 DOI: 10.3390/jcm11206030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/03/2022] [Accepted: 10/11/2022] [Indexed: 11/17/2022] Open
Abstract
Obesity and kidney transplantation (KTx) are closely related. Obesity increases the risk of chronic kidney disease and can be a relative contraindication for KTx. Besides, KTx recipients are predisposed to obesity and its comorbidities. Consequently, bariatric surgery (BS) emerges as a powerful therapeutic tool either before or after KTx. Since evidence regarding the best approach is still scarce, we aimed to describe renal and metabolic outcomes in a single centre with more than 15-year experience in both surgeries. Methods: A retrospective study including patients who had received a KTx either before or after BS. Usual metabolic and renal outcomes, but also new variables (as renal graft dysfunction) were collected for a minimum follow-up of 1-year post-BS. Results: A total of 11 patients were included: n = 6 (BS-post-KTx) and n = 5 (BS-pre-KTx). One patient was assessed in both groups. No differences in the main outcomes were identified, but BS-post-KTx group tended to gain more weight during the follow-up. The incidence of renal graft dysfunction was comparable (4/6 for BS-post-KTx, 3/5 for BS-pre-KTx) between groups. Conclusions: BS in patients with KTx appears to be safe and effective attending to metabolic and renal outcomes. These results seem irrespective of the time course, except for weight regain, which appears to be a common pattern in the BS-post-KTx group.
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12
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Touzot M, Ureña-Torres P, Dupuy O. Semaglutide for treatment of obesity in hemodialysis patients waiting for a kidney transplant: new hope? Clin Kidney J 2022; 15:1782-1784. [PMID: 36003674 PMCID: PMC9394711 DOI: 10.1093/ckj/sfac090] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Indexed: 11/30/2022] Open
Abstract
Obesity limits the access to kidney transplantation and increases the risk of complications and mortality posttransplantation. Usual noninvasive measures, including lifestyle changes and dietary education, do not provide long-term and consistent body weight reduction. In many cases, only bariatric surgery allows patients to significantly reduce body weight. We here report two cases of obese hemodialysis (HD) patients who were successfully treated with off-labeled semaglutide, a glucagon-like peptide receptor agonist (GLP-1RA). The first patient had a body mass index (BMI) of 45.7 kg/m2 despite a history of partial gastrectomy. The second patient had a history of type 2 diabetes mellitus and a BMI of 36.5 kg/m2. Both patients started semaglutide at the maximal subcutaneous dose of 1 mg/week, which was clinically well tolerated. During the 9-month follow-up, body weight loss ranged from 6.5 to 9.0 kg, ∼1 kg/month. GLP-1RAs, such as semaglutide or liraglutide, could be a novel pharmacological alternative to bariatric surgeries for these HD patients.
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Affiliation(s)
- Maxime Touzot
- AURA Paris Plaisance, Dialyse et aphérèse thérapeutique, Paris, France
| | | | - Olivier Dupuy
- Service de diabétologie, Groupe Hospitalier Saint-joseph, Paris, France
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13
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Matteo MV, Bove V, Pontecorvi V, De Siena M, Taibi C, Costamagna G, Boškoski I. Endoscopic Sleeve Gastroplasty as a Therapeutic Chance for Obese Patients not Eligible for Organ Transplantation. Obes Surg 2022; 32:2460-2462. [PMID: 35294691 DOI: 10.1007/s11695-022-06008-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/03/2022] [Accepted: 03/09/2022] [Indexed: 12/19/2022]
Affiliation(s)
- Maria Valeria Matteo
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8 00168, Rome, Italy. .,Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, 00168, Rome, Italy.
| | - Vincenzo Bove
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8 00168, Rome, Italy.,Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Valerio Pontecorvi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8 00168, Rome, Italy.,Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Martina De Siena
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8 00168, Rome, Italy.,Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Chiara Taibi
- Hepatology and Infectious Diseases Department, National Institute for Infectious Diseases, Lazzaro Spallanzani-IRCCS, 00149, Rome, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8 00168, Rome, Italy.,Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Ivo Boškoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8 00168, Rome, Italy.,Centre for Endoscopic Research Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore, 00168, Rome, Italy
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