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Review
. 2019 Jun;47(6):2326-2341.
doi: 10.1177/0300060519843755. Epub 2019 Apr 21.

Obesity and bariatric intervention in patients with chronic renal disease

Maria Irene Bellini  1 , Filippo Paoletti  2 , Paul Elliot Herbert  1   3
Affiliations
Review

Obesity and bariatric intervention in patients with chronic renal disease

Maria Irene Bellini et al. J Int Med Res. 2019 Jun.

Abstract

Obesity is associated with chronic metabolic conditions that directly and indirectly cause kidney parenchymal damage. A review of the literature was conducted to explore existing evidence of the relationship between obesity and chronic kidney disease as well as the role of bariatric surgery in improving access to kidney transplantation for patients with a high body mass index. The review showed no definitive evidence to support the use of a transplant eligibility cut-off parameter based solely on the body mass index. Moreover, in the pre-transplant scenario, the obesity paradox is associated with better patient survival among obese than non-obese patients, although promising results of bariatric surgery are emerging. However, until more information regarding improvement in outcomes for obese kidney transplant candidates is available, clinicians should focus on screening of the overall frailty condition of transplant candidates to ensure their eligibility and addition to the wait list.

Keywords: Obesity; bariatric surgery; body mass index; chronic kidney disease; kidney transplant; obesity paradox.

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Figures

Figure 1.
Figure 1.
Prognosis of CKD according to GFR and albuminuria categories: KDIGO 2012. Green indicates low risk (if no other markers of kidney disease are present), yellow indicates moderately increased risk, orange indicates high risk, and red indicates very high risk. CKD, chronic kidney disease; GFR, glomerular filtration rate; KDIGO, Kidney Disease: Improving Global Outcomes.
Figure 2.
Figure 2.
High BMI guidelines. No unanimous consensus has been reached regarding the management of obese candidates for kidney transplantation. BMI, body mass index; KDIGO, Kidney Disease: Improving Global Outcomes; KTRs, kidney transplant recipients; NICE, National Institute for Health and Care Excellence.
Figure 3.
Figure 3.
Obesity impacts every phase of kidney transplantation. BMI, body mass index; RR, relative risk; DGF, delayed graft function.
Figure 4.
Figure 4.
Restrictive procedures. (a) Laparoscopic gastric banding. (b) Laparoscopic sleeve gastrectomy. (c) Laparoscopic Roux-en-y gastric bypass.
See this image and copyright information in PMC

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