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Laparoscopic Sleeve Gastrectomy is a Novel and Effective Treatment for Obesity in Patients with Chronic Kidney Disease

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Abstract

Obesity increases the risk of progression of chronic kidney disease (CKD) towards kidney failure and may preclude access to kidney transplantation. Weight loss surgery remains relatively novel in obese patients with CKD, with several studies reporting results using Roux-en-Y bypass and adjustable gastric banding. However, in obese patients with CKD, kidney failure after bypass surgery and gastric band erosion after kidney transplantation have been reported. We present the first report of laparoscopic sleeve gastrectomy (LSG) performed for the treatment of obesity in patients with CKD. Weight loss, blood pressure and lipids, estimated kidney function, surgical complications and adverse events were studied. Nine obese patients with CKD (five of whom were undergoing haemodialysis treatment) underwent LSG, with median body mass index decrease of 8.4 kg/m2 and excess weight loss of 43.0% after 6 months. Four of the five patients on haemodialysis were added to the kidney transplantation waiting list as a result of weight loss achieved with LSG. Adverse events occurred in three patients: myocardial infarction (one patient), acute kidney injury secondary to dehydration (one patient) and compromised dialysis access (one patient). There was one complication—a gastric leak, detected 7 months after LSG, requiring further surgical intervention and nasojejunal feeding, and no mortality. Our preliminary evidence suggests that LSG is an effective treatment for obesity in patients with CKD. However, there may be additional risk associated with the procedure in patients with CKD, requiring further study.

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References

  1. Hsu C, McCulloch CE, Iribarren C, et al. Body mass index and risk for end-stage renal disease. Ann Intern Med. 2006;144:21–8.

    PubMed  Google Scholar 

  2. Axelsson J. The emerging biology of adipose tissue in chronic kidney disease: from fat to facts. Nephrol Dial Transplant. 2008;23:3041–6.

    Article  PubMed  Google Scholar 

  3. Becker B, Kronenberg F, Kielstein JT, et al. Renal insulin resistance syndrome, adiponectin and cardiovascular events in patients with kidney disease: the mild and moderate kidney disease study. J Am Soc Nephrol. 2005;16:1091–8.

    Article  PubMed  CAS  Google Scholar 

  4. Teplan V, Vyhnanek F, Gurlich R, et al. Increased proinflammatory cytokine production in adipose tissue of obese patients with chronic kidney disease. Wien Klin Wochen. 2010;122:466–73.

    Article  CAS  Google Scholar 

  5. Kramer H, Luke A, Bidani A, et al. Obesity and prevalent and incident CKD: the Hypertension Detection and Follow-Up Program. Am J Kidney Dis. 2005;46:587–94.

    Article  PubMed  Google Scholar 

  6. Kramer HJ, Saranathan A, Luke A, et al. Increasing body mass index and obesity in the incident ESRD population. J Am Soc Nephrol. 2006;17:1453–9.

    Article  PubMed  Google Scholar 

  7. Segev DL, Simpkins CE, Thompson RE, et al. Obesity impacts access to kidney transplantation. J Am Soc Nephrol. 2008;19:349–55.

    Article  PubMed  Google Scholar 

  8. Cacciola RAS, Pujar K, Ilham MA, et al. Effect of degree of obesity on renal transplant outcome. Transplant Proc. 2008;40:3408–12.

    Article  PubMed  CAS  Google Scholar 

  9. Abbott KC, Glanton CW, Trespalacios FC, et al. Body mass index, dialysis modality, and survival: analysis of the United States Renal Data System Dialysis Morbidity and Mortality Wave II Study. Kidney Int. 2004;65:597–605.

    Article  PubMed  Google Scholar 

  10. Chazot C, Gassia JP, Di Benedetto A, et al. Is there any survival advantage of obesity in Southern European haemodialysis patients? Nephrol Dial Transplant. 2009;24:2871–6.

    Article  PubMed  Google Scholar 

  11. Kalantar-Zadeh K, Kopple JD, Kilpatrick RD, et al. Association of morbid obesity and weight change over time with cardiovascular survival in hemodialysis population. Am J Kidney Dis. 2005;46:489–500.

    Article  PubMed  Google Scholar 

  12. Navaneethan SD, Yehnert H, Moustarah F, et al. Weight loss interventions in chronic kidney disease: a systematic review and meta-analysis. Clin J Am Soc Nephrol. 2009;4:1565–74.

    Article  PubMed  Google Scholar 

  13. Sjostrom L. Surgical intervention as a strategy for treatment of obesity. Endocr. 2000;13:213–30.

    Article  CAS  Google Scholar 

  14. Picot J, Jones J, Colquitt JL, et al. The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technol Assess. 2009;13(41):1–358.

    Google Scholar 

  15. Agrawal V, Khan I, Rai B, et al. The effect of weight loss after bariatric surgery on albuminuria. Clin Nephrol. 2008;70:194–202.

    PubMed  CAS  Google Scholar 

  16. Navarro-Diaz M, Serra A, Romero R, et al. Effect of drastic weight loss after bariatric surgery on renal parameters in extremely obese patients: long-term follow-up. J Am Soc Nephrol. 2006;17:S213–7.

    Article  PubMed  Google Scholar 

  17. Chagnac A, Weinstein T, Herman M, et al. The effects of weight loss on renal function in patients with severe obesity. J Am Soc Nephrol. 2003;14:1480–6.

    Article  PubMed  Google Scholar 

  18. Afshinnia F, Wilt TJ, Duval S, et al. Weight loss and proteinuria: systematic review of clinical trials and comparative cohorts. Nephrol Dial Transplant. 2010;25:1173–83.

    Article  PubMed  Google Scholar 

  19. Alexander JW, Goodman HR, Hawver LRM, et al. Improvement and stabilization of chronic kidney disease after gastric bypass. Surg Obes Relat Dis. 2009;5:237–41.

    Article  PubMed  Google Scholar 

  20. Navaneethan SD, Yehnert H. Bariatric surgery and progression of chronic kidney disease. Surg Obes Relat Dis. 2009;5:662–5.

    Article  PubMed  Google Scholar 

  21. Koshy AN, Coombes JS, Wilkinson S, et al. Laparoscopic gastric banding surgery performed in obese dialysis patients prior to kidney transplantation. Am J Kidney Dis. 2008;52:E15–7.

    Article  PubMed  Google Scholar 

  22. Takata MC, Campos GM, Ciovica R, et al. Laparoscopic bariatric surgery improves candidacy in morbidly obese patients awaiting transplantation. Surg Obes Relat Dis. 2008;4:159–64.

    Article  PubMed  Google Scholar 

  23. Nasr SH, D'Agati VD, Said SM, et al. Oxalate nephropathy complicating Roux-en-Y gastric bypass: an underrecognized cause of irreversible renal failure. CJ Am Soc Nephrol. 2008;3:1676–83.

    Article  Google Scholar 

  24. Nelson WK, Houghton SG, Milliner DS, et al. Enteric hyperoxaluria, nephrolithiasis, and oxalate nephropathy: potentially serious and unappreciated complications of Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2005;1:481–5.

    Article  PubMed  Google Scholar 

  25. Sinha MK, Collazo-Clavell ML, Rule A, et al. Hyperoxaluric nephrolithiasis is a complication of Roux-en-Y gastric bypass surgery. Kidney Int. 2007;72:100–7.

    Article  PubMed  CAS  Google Scholar 

  26. Buch KE, El-Sabrout R, Butt KM. Complications of laparoscopic gastric banding in renal transplant recipients: a case study. Transplant Proc. 2006;38:3109–11.

    Article  PubMed  CAS  Google Scholar 

  27. Semins MJ, Asplin JR, Steele K, et al. The effect of restrictive bariatric surgery on urinary stone risk factors. Urology. 2010;76:826–9.

    Article  PubMed  Google Scholar 

  28. Himpens J, Dapri G, Cadiere GB. A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg. 2006;16:1450–6.

    Article  PubMed  Google Scholar 

  29. Karamanakos SN, Vagenas K, Kafarentzos F, et al. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy—a prospective, double blind study. Ann Surg. 2008;247:401–7.

    Article  PubMed  Google Scholar 

  30. Roa PE, Kaidar-Person O, Pinto D, et al. Laparoscopic sleeve gastrectomy as treatment for morbid obesity: technique and short-term outcome. Obes Surg. 2006;16:1323–6.

    Article  PubMed  Google Scholar 

  31. Levey AS, Bosch JP, Lewis JB, et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999;130:461–70.

    PubMed  CAS  Google Scholar 

  32. Levey AS, Greene T, Kusek JW, et al. A simplified equation to predict glomerular filtration rate from serum creatinine (abstract). J Am Soc Nephrol. 2000;11:0828A.

    Google Scholar 

  33. Deitel M, Gawdat K, Melissas J. Reporting weight loss 2007. Obes Surg. 2007;17:565–8.

    Article  PubMed  Google Scholar 

  34. Brethauer SA, Hammel JP, Schauer PR. Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surg Obes Relat Dis. 2009;5:469–75.

    Article  PubMed  Google Scholar 

  35. Go AS, Chertow GM, Fan D, et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351:1296–305.

    Article  PubMed  CAS  Google Scholar 

  36. Sarnak MJ, Levey AS, Schoolwerth AC, et al. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Circulation. 2003;108:2154–69.

    Article  PubMed  Google Scholar 

  37. Snyder-Marlow G, Taylor D, Lenhard MJ. Nutrition care for patients undergoing laparoscopic sleeve gastrectomy for weight loss. J Am Diet Assoc. 2010;110:600–7.

    Article  PubMed  Google Scholar 

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Conflict of Interest Statement

The results presented in this paper have not been published or submitted previously in whole or in part. There are no conflicts of interest to declare.

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Authors and Affiliations

  1. Diabetes and Nutritional Sciences, School of Medicine, King’s College London, London, UK

    Helen L. MacLaughlin & Wendy L. Hall

  2. School of Medicine, King’s College London, London, UK

    Ameet G. Patel & Iain C. Macdougall

  3. Department of Nutrition and Dietetics, King’s College Hospital, Denmark Hill, SE5 9RS, London, UK

    Helen L. MacLaughlin

  4. Department of Surgery, King’s College Hospital, Denmark Hill, SE5 9RS, London, UK

    Ameet G. Patel

  5. Department of Renal Medicine, King’s College Hospital, Denmark Hill, SE5 9RS, London, UK

    Iain C. Macdougall

Authors
  1. Helen L. MacLaughlin
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  2. Wendy L. Hall
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  4. Iain C. Macdougall
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Correspondence to Helen L. MacLaughlin.

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MacLaughlin, H.L., Hall, W.L., Patel, A.G. et al. Laparoscopic Sleeve Gastrectomy is a Novel and Effective Treatment for Obesity in Patients with Chronic Kidney Disease. OBES SURG 22, 119–123 (2012). https://doi.org/10.1007/s11695-011-0448-4

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  • DOI: https://doi.org/10.1007/s11695-011-0448-4

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