title: Laparoscopic sleeve gastrectomy is a novel and effective treatment for obesity in patients with chronic kidney disease.
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/m(2) 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.
authors: Diabetes and Nutritional Sciences, School of Medicine, King's College London, London, UK. helen.maclaughlin@nhs.net
authors: Helen L
authors: HL
authors: MacLaughlin
authors: Wendy L
authors: WL
authors: Hall
authors: Ameet G
authors: AG
authors: Patel
authors: Iain C
authors: IC
authors: Macdougall
references: Ann Surg. 2008 Mar;247(3):401-7
references: 18376181
references: J Am Diet Assoc. 2010 Apr;110(4):600-7
references: 20338286
references: Surg Obes Relat Dis. 2008 Mar-Apr;4(2):159-64; discussion 164-5
references: 18294923
references: Nephrol Dial Transplant. 2009 Sep;24(9):2871-6
references: 19369686
references: Surg Obes Relat Dis. 2009 Jul-Aug;5(4):469-75
references: 19632646
references: Obes Surg. 2007 May;17(5):565-8
references: 17658011
references: J Am Soc Nephrol. 2006 May;17(5):1453-9
references: 16597682
references: Surg Obes Relat Dis. 2009 Mar-Apr;5(2):237-41
references: 18996757
references: Clin J Am Soc Nephrol. 2008 Nov;3(6):1676-83
references: 18701613
references: Am J Kidney Dis. 2005 Sep;46(3):489-500
references: 16129211
references: Circulation. 2003 Oct 28;108(17):2154-69
references: 14581387
references: Kidney Int. 2004 Feb;65(2):597-605
references: 14717930
references: J Am Soc Nephrol. 2005 Apr;16(4):1091-8
references: 15743998
references: Endocrine. 2000 Oct;13(2):213-30
references: 11186223
references: Obes Surg. 2006 Nov;16(11):1450-6
references: 17132410
references: N Engl J Med. 2004 Sep 23;351(13):1296-305
references: 15385656
references: Am J Kidney Dis. 2008 Oct;52(4):e15-7
references: 18617303
references: Ann Intern Med. 2006 Jan 3;144(1):21-8
references: 16389251
references: Transplant Proc. 2006 Nov;38(9):3109-11
references: 17112911
references: Ann Intern Med. 1999 Mar 16;130(6):461-70
references: 10075613
references: J Am Soc Nephrol. 2003 Jun;14(6):1480-6
references: 12761248
references: Clin J Am Soc Nephrol. 2009 Oct;4(10):1565-74
references: 19808241
references: Health Technol Assess. 2009 Sep;13(41):1-190, 215-357, iii-iv
references: 19726018
references: Kidney Int. 2007 Jul;72(1):100-7
references: 17377509
references: Am J Kidney Dis. 2005 Oct;46(4):587-94
references: 16183412
references: Nephrol Dial Transplant. 2010 Apr;25(4):1173-83
references: 19945950
references: J Am Soc Nephrol. 2008 Feb;19(2):349-55
references: 18094366
references: Urology. 2010 Oct;76(4):826-9
references: 20381135
references: Nephrol Dial Transplant. 2008 Oct;23(10):3041-6
references: 18632589
references: Surg Obes Relat Dis. 2005 Sep-Oct;1(5):481-5
references: 16925274
references: Transplant Proc. 2008 Dec;40(10):3408-12
references: 19100400
references: J Am Soc Nephrol. 2006 Dec;17(12 Suppl 3):S213-7
references: 17130264
references: Surg Obes Relat Dis. 2009 Nov-Dec;5(6):662-5
references: 19359221
references: Wien Klin Wochenschr. 2010 Aug;122(15-16):466-73
references: 20658196
references: Clin Nephrol. 2008 Sep;70(3):194-202
references: 18793560
references: Obes Surg. 2006 Oct;16(10):1323-6
references: 17059741