Gastric Bypass in Chronic Renal Failure and Renal Transplant

Abstract

Background: Morbid obesity has reached epidemic proportions in developed nations worldwide, causing considerable mortality and increased healthcare expenditures. The use of gastric bypass surgery to achieve weight loss in morbidly obese patients with chronic renal failure (CRF) and postrenal transplant patients has not been studied adequately. Methods: Forty-one patients with different stages of CRF (25 already receiving dialysis) underwent a gastric bypass (GBP), and an additional 10 patients underwent a GBP after becoming morbidly obese after transplantation. Results: Of the 41 patients with CRF, 5 stabilized or resolved their kidney disease and 9 underwent successful transplantation. These patients had a loss of 68% excess body mass index (BMI) by 12 months after GBP. Of the 10 patients with GBP after transplant, the mean loss of excess BMI was 70.5%. There were no in-hospital or 30-day mortalities, but 8 of the 51 patients died from 112 to 2869 days postoperatively, 7 from cardiac or vascular events and 1 from an automobile accident. This compares with an approximate 10% mortality per year for patients receiving dialysis. Comorbid conditions associated with morbid obesity improved in all patients and permitted eligibility for transplantation. Conclusions: GBP for massive weight reduction in morbidly obese renal failure and transplant patients leads to a reduction in comorbid conditions that are associated with an increased risk for cardiovascular deaths. There was no operative mortality in this series, and all but 1 death were related to previously existing disease of the cardiovascular system.

Get full access to this article

View all access options for this article.

References

McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA. 1993;270:2207– 2212.

U.S. Department of Health and Human Services. The Surgeon General's call to action to prevent and decrease overweight and obesity 2001. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General,2001 .

Fontaine KR, Redden DT, Wang C, Westfall AO, Allison DB. Years of life lost due to obesity. JAMA. 2003 ;289:187– 193.

Stevens J, Cai J, Pamuk ER, Williamson DF, Thun MJ, Wood JL. The effect of age on the association between body-mass index and mortality. N Engl J Med. 1998 ;338:1– 7.

Christou NV, Sampolis JS, Liberman M, et al. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg. 2004 ;240:416– 423.

Alexander JW, Goodman HR, Gersin K, et al. Gastric bypass in morbidly obese patients with chronic renal failure and kidney transplant. Transplantation. 2004 ;78:469– 474.

Alexander JW, Rahn R. Prevention of deep wound infection in morbidly obese patients by infusion of an antibiotic into the subcutaneous space at the time of wound closure. Obes Surg. 2004 ;14:970– 974.

Salahudeen AK. Obesity and survival on dialysis. Am J Kidney Dis. 2003;41:925– 932.

Degoulet P, Legrain M, Reach I, et al. Mortality risk factors in patients treated by chronic hemodialysis: report of the Diaphane Collaborative Study. Nephron. 1982 ;31:103– 110.

10.

Fleischmann E, Teal N, Dudley J, May W, Bower JD, Salahudeen AK. Influence of excessive weight on mortality and hospital stay in 1346 hemodialysis patients. Kidney Int. 1999 ;55:1560– 1567.

11.

Johansen KL, Young B, Kaysen GA, Chertow GM. Association of body size with outcomes among patients beginning dialysis. Am J Clin Nutr. 2004;80:324– 332.

12.

Kalantar-Zadeh K, Abbott KC, Salahudeen AK, Kilpatrick RD, Horwich TB. Survival advantages of obesity in dialysis patients. Am J Clin Nutr. 2005;81:543– 554.

13.

Combe C, Chauveau P, Laville M, et al; French Study Group. Nutrition in Dialysis. Influence of nutritional factors and hemodialysis adequacy on the survival of 1,610 French patients. Am J Kidney Dis. 2001;37(suppl 2): S81–S88.

14.

Caravaca F, Martin MV, Barroso S, et al. Obesity and mortality in advanced chronic renal failure patients. Nefrologia. 2004 ;24:453– 462.

15.

Meier-Kriesche H-U, Arndorfer JA, Kaplan B. The impact of body mass index on renal transplant outcomes: a significant independent risk factor for graft failure and patient death. Transplantation. 2002 ;73:70– 74.

16.

Bennett WM, McEvoy KM, Hennell KR, Valente JF, Douzdjian V. Morbid obesity does not preclude successful renal transplantation. Clin Transplant. 2004;18:89– 93.

17.

Marks WH, Florence LS, Chapman PH, Precht AF, Perkinson DT. Morbid obesity is not a contraindication to kidney transplantation. Am J Surg. 2004;187:635– 638.

18.

Armstrong KA, Campbell SB, Hawley CM, Johnson DW, Isbel NM. Impact of obesity on renal transplant outcomes. Nephrology. 2005 ;10:405– 413.

19.

Pelletier SJ, Maraschio MA, Schaubel DE, et al. Survival benefit of kidney and liver transplantation for obese patients on the waiting list. Clin Transplant. 2003;77– 88.

20.

Jardine AG, Fellstrom B, Logan JO, et al. Cardiovascular risk and renal transplantation: post hoc analyses of the Assessment of Lescol in Renal Transplantation (ALERT) Study. Am J Kidney Dis. 2005 ;46:529– 536.

21.

el-Agroudy AE, Wafa EW, Gheith OE, Shehab el-Dein AB, Ghoneim MA. Weight gain after renal transplantation is a risk factor for patient and graft outcome. Transplantation. 2004 ;77:1381– 1385.

22.

Alsabrook GD, Goodman HR, Alexander JW. Gastric bypass surgery for morbidly obese patients with established cardiac disease. Obes Surg. 2006;16:1272– 1277.

23.

Nielsen JV, Westerlund P, Bygren P. A low-carbohydrate diet may prevent end-stage renal 2 diabetes: a case report. Nutr Metab. 2006;3:23– 27.

24.

Agnani S, Vachharajani VT, Gupta R, Atray NK, Vachharajani TJ. Does treating obesity stabilize chronic kidney disease? BMC Nephrol. 2005;6:7– 10.

25.

Soto FC, Higa-Sansone G, Copley JB, et al. Renal failure, glomerulonephritis and morbid obesity: improvement after rapid weight loss following laparoscopic gastric bypass. Obes Surg. 2005 ;15:137– 140.

26.

Izzedine H, Coupaye M, Reach I, Deray G. Gastric bypass and resolution of proteinuria in an obese diabetic patient. Diabet Med. 2005;22:1761– 1762.

27.

Newcombe V, Blanch A, Slater GH, Szold A, Fielding GA. Laparoscopic adjustable gastric banding prior to renal transplantation. Obes Surg. 2005;15:567– 570.

28.

Weiss H, Nehoda H, Labeck B, Oberwalder M, Konigsrainer A, Margreiter R. Organ transplantation and obesity: evaluation, risks and benefits of therapeutic strategies. Obes Surg. 2000 ;10:465– 469.

29.

Meier-Kriesche HU, Schold JD, Srinivas TR, Reed A, Kaplan B. Kidney transplantation halts cardiovascular disease progression in patients with end-stage renal disease. Am J Transplant. 2004 ;4:1662– 1668.

30.

Pischon T, Sharma A. Obesity as a risk factor in renal transplant patients. Nephrol Dial Transplant. 2001 ;16:14– 17.

31.

Srinivas TR, Meier-Kriesche H-U. Obesity and kidney transplantation. Contrib Nephrol. 2006 ;151:19– 41.