title: Challenges of treating a 466-kilogram man with acute kidney injury.
abstract: Caring for super obese patients (body mass index > 50 kg/m(2)) presents a number of complex and unique clinical challenges, particularly when acute kidney injury is present. We describe our experience treating the heaviest individual with acute kidney injury requiring renal replacement therapy reported to date. A 24-year-old black man was admitted to our hospital with fever, vomiting, progressive weakness, shortness of breath, and hemoptysis. Admission weight was 1,024 lbs (466 kg), height was 6 ft 4 in (1.9 m), and body mass index was 125 kg/m(2). During hospitalization, the patient experienced oligoanuric acute kidney injury and required initiation of continuous and subsequently intermittent renal replacement therapy. This clinical scenario identifies the many challenges involved in caring for super obese patients with acute kidney injury and may be a harbinger of what awaits the nephrology community in the obesity pandemic era.
authors.affiliation: Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN; Interdepartmental Nutrition Program, Purdue University, West Lafayette, IN, USA. allfried@iupui.edu
authors.forename: Allon N
authors.initials: AN
authors.lastname: Friedman
authors.forename: Brian
authors.initials: B
authors.lastname: Decker
authors.forename: Louis
authors.initials: L
authors.lastname: Seele
authors.forename: Richard N
authors.initials: RN
authors.lastname: Hellman
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000628:therapy*; D000328:Adult; D015992:Body Mass Index; D016638:Critical Illness / Q000628:therapy*; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D009767:Obesity, Morbid / Q000175:diagnosis*; D016079:Refusal to Treat; D006435:Renal Dialysis / Q000379:methods; D018570:Risk Assessment