Abstract: FR-PO824
Successful Bariatric Laparoscopic Sleeve Gastrectomy in a Home Hemodialysis Patient Led to Reduced Hemodialysis Frequency
Session Information
- Health Maintenance, Nutrition, Metabolism - II
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Health Maintenance, Nutrition, and Metabolism
- 1500 Health Maintenance, Nutrition, and Metabolism
Authors
- de Waal, Desiree, University of Vermont Larner College of Medicine, Burlington, Vermont, United States
- Onuigbo, Macaulay A., University of Vermont Larner College of Medicine, Burlington, Vermont, United States
Introduction
Bariatric surgery (BS) is an established treatment for achieving weight loss. Patients with kidney disease and not on dialysis had a reduction in mortality compared to matched controls with vertical laparoscopic sleeve gastrectomy (LSG) being the safer option compared to Roux-en-Y gastric bypass. Use of BS in dialysis patients is not common due to fears of complications including high post-operative mortality and myocardial infarction. Furthermore, observational studies suggest a protective association of elevated BMI versus death in HD patients, although this has not been consistently observed in peritoneal dialysis patients. Our patient demonstrated that BS while on HHD is a desirable option to achieve target weight loss.
Case Description
A 36-year-old female started HHD for anuric hypertensive end stage renal disease 5.5 years before LSG. Before LSG, she did HHD 5 times a week to maintain adequacy. The renal and bariatric teams worked closely to provide a unified approach to her diet pre- and post-surgery, which included fluid diets and progression to solids. Medications and supplements were also adjusted to meet both dialysis and bariatric guidelines. Since LSG, she has exhibited progressive weight loss of 26% over 6 months (Figure), while maintaining her nutritional status. We reduced HHD frequency from five to four times weekly to mitigate intradialytic hypotension, and still maintained HD adequacy. She is more active, more energetic, takes longer walks, twice daily, and now works in her garden.
Discussion
Our HHD patient had successful bariatric surgery with 26% weight loss in 6 months and can now be listed for kidney transplant. Despite a paucity of literature on intentional approaches to weight loss in ESRD, LSG is increasingly used for patients with kidney failure and severe obesity. More research is needed to assess long-term cardiovascular and kidney transplant outcomes following BS.
BMI changes after LSG