title: Safety and effectiveness of bariatric surgery in dialysis patients and kidney transplantation candidates.
abstract: BACKGROUND
  Chronic renal disease is known to adversely affect the results of bariatric surgery. There is a paucity of literature on the safety and effectiveness of bariatric surgery on dialysis patients who are at very advanced stages in their renal disease. The objective of this study was to determine the safety and effectiveness of bariatric surgery in dialysis patients.
  
  
  METHODS
  A retrospective review of a prospectively collected database was conducted for dialysis patients who underwent bariatric surgery between January 2006 and January 2012. Age, gender, body mass index (BMI), cause of renal failure, associated co-morbidities, type of surgery, early and late complications, and mortality were collected.
  
  
  RESULTS
  Of the 3048 patients undergoing bariatric surgery during the study period, 21 dialysis patients (.7%) were identified. Eighteen patients underwent laparoscopic Roux-en-Y gastric bypass (LRYGB), 2 patients underwent laparoscopic sleeve gastrectomy, and 1 patient underwent laparoscopic adjustable gastric banding. Mean preoperative BMI was 47.1±5.5 kg/m(2), and BMI decreased to 35.3±8.4 kg/m(2) after a mean follow-up period of 27.6 months (range = 1.4-78.0 mo). Early major complications (<30 days of surgery) occurred in 2 patients (1 anastomotic leak and 1 anastomotic stricture). Four patients had a late complication, including 1 marginal ulcer with bleeding managed endoscopically, 1 small bowel obstruction requiring laparoscopic lysis of adhesions, 1 cholecystitis requiring cholecystectomy, and 1 anastomotic stricture requiring endoscopic dilation. There was 1 death in this cohort, at 45 days after LRYGB, that was unrelated to a surgery.
  
  
  CONCLUSIONS
  Chronic renal failure requiring dialysis should not be considered a contraindication to bariatric surgery. Our experience with this patient population has shown excellent medium-term weight loss and an acceptable (albeit increased) risk/benefit ratio.
authors: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Surgery, Kuwait University, Kuwait City, Kuwait.
authors: Mohammad H
authors: MH
authors: Jamal
authors: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic of Barcelona, Barcelona, Spain.
authors: Ricard
authors: R
authors: Corcelles
authors: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
authors: Christopher R
authors: CR
authors: Daigle
authors: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
authors: Tomasz
authors: T
authors: Rogula
authors: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
authors: Matthew
authors: M
authors: Kroh
authors: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
authors: Philip R
authors: PR
authors: Schauer
authors: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: brethas@ccf.org.
authors: Stacy A
authors: SA
authors: Brethauer
mesh_terms: D000328:Adult; D050110:Bariatric Surgery; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D016030:Kidney Transplantation; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications* / Q000601:surgery*; D006435:Renal Dialysis; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Dialysis; Renal transplantation; morbid obesity.