Weight loss after bariatric surgery may lead to drop in HHD frequency
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Key takeaways:
- A patient who underwent bariatric surgery reduced her home hemodialysis sessions from five treatments to four treatments per week.
- Researchers said the patient’s weight loss led to lower body volume.
LONG BEACH, Calif. — A patient on dialysis who lost weight after bariatric surgery was able to reduce the number of home hemodialysis sessions from five to four treatments without adverse outcomes, researchers said here.
“Bariatric surgery (BS) is an established treatment for achieving weight loss in morbidly obese patients. Patients with [chronic kidney disease] but not on dialysis who had BS experienced reduced mortality compared to matched controls,” Macaulay Onuigbo, MD, MSc, MBA, FWACP, FASN, a consultant nephrologist and professor of medicine at the Robert Larner, MD College of Medicine at the University of Vermont, and colleagues wrote in a poster presented at the National Kidney Foundation Spring Clinical Meetings.
“There remain concerns regarding [postoperative] complications including mortality and myocardial infarction,” the authors wrote. “Furthermore, there remains controversy about the role of weight loss interventions in patients with kidney failure on dialysis ... observational studies suggest a protective association of elevated BMI [vs.] death in hemodialysis patients.”
The patient, a 36-year-old woman who had been on dialysis for 5.5 years, was on maintenance HHD five times a week and achieved more than a 40% weight reduction after laparoscopic sleeve gastrectomy (LSG) was performed.
“The patient weighed 181.1 kg pre-bariatric surgery, and she currently weighs 96.5 kg as of May 2024,” Onuigbo told Healio. “She did not make much urine. Her pre-bariatric surgery home hemodialysis prescription was hemodialysis via a left forearm AV fistula, a duration of 4 hours, five days a week, and her weekly delivered Kt/V was usually around 2.2 to 2.3 units,” Onuigbo said.
At a dialysis clinic visit in mid-November 2022, the patient’s weekly Kt/V was 2.91 units, and that “empowered us to decide to reduce her home hemodialysis treatments,” Onuigbo told Healio. “This higher delivered Kt/V was not anticipated following the bariatric surgery, particularly this early,” Onuigbo said.
The patient has generally maintained a delivered weekly Kt/V of 2.2 to 2.3 units. “The presumption is that with the loss of total body mass and body weight, total body volume has been significantly modified. She is now out gardening actively with the coming of spring, taking long walks daily and is one step away from being actively listed for kidney transplantation,” Onuigbo told Healio.
“BS is an excellent option to help a patient lose weight with the potential to reach BMI goals for kidney transplantation,” the authors concluded. “Despite a paucity of literature on intentional approaches to weight loss in [end-stage renal disease] 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. Finally, the novel concept of personalized decremental hemodialysis was validated with our patient. This again calls for further investigation,” the authors wrote.
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Onuigbo M, et al. Poster 427. Presented at: NKF Spring Clinical Meetings; May 14-18, 2024; Long Beach, Calif.
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