Aug. 17, 2024
In the United States, approximately 40% of patients on dialysis meet clinical criteria for obesity. Consequently, patients with obesity represent the fastest-growing population with advanced chronic kidney disease (CKD). Unfortunately, many of these patients are not eligible for kidney transplant listing because of an elevated body mass index (BMI) that falls above transplant BMI criteria.
Weight-loss therapies in patients with CKD have not been extensively studied. Due to the observed association between higher BMI and survival, there is a general view that a higher BMI is beneficial, particularly for those on dialysis. However, patients whose kidney transplants are delayed due to not meeting the BMI cutoff are also at higher risk of mortality.
Aleksandra Kukla, M.D., a transplant nephrologist at Mayo Clinic in Rochester, Minnesota, explains: "The aim of our retrospective study was to describe the outcomes in candidates for kidney transplantation with obesity who were undergoing sleeve gastrectomy (SG) to meet BMI criteria for kidney transplant.
"These patients were participants in the Transplant Metabolic (TRANSMET) Program between February 2020 and August 2023. We compared 54 patients who underwent SG with 50 patients who did not have surgery. Mean BMI was similar in both groups at 41.7 kg/m2."
According to the study results, patients on dialysis achieved similar weight-loss results to those who were not on dialysis. Over the median follow-up period of 15.5 months, SG led to active listing in 37 of 54 (69%) of patients, and 20 of 54 (37%) received transplants within 20 months of undergoing SG. In contrast, 14 of 50 (28%) nonsurgical patients were actively listed, and 5 of 50 (10%) underwent kidney transplants.
Meera Shah, M.B., Ch.B., Endocrinology, Diabetes and Nutrition, at Mayo Clinic in Rochester, Minnesota, continues, "The bariatric transplant program consists of a multidisciplinary team that assesses candidates for weight-loss surgery to ensure minimal perioperative complications and optimal long-term outcomes."
There was no difference in major health adverse outcomes or hospitalizations between the groups in this study. However, there was a trend toward a decline in physical performance and an increase in frailty scores from before SG to after SG in the surgical group, which occurred in the context of a known increase in the prevalence of sarcopenia after bariatric surgery.
Dr. Kukla concludes: "The findings of this study support the role of SG in CKD patients with obesity awaiting kidney transplant. As we further develop treatment protocols for obesity in CKD patients, we should include interventions to preserve or improve physical functioning, including physical therapy or health and wellness coaching. Although SG can be safe and effective in this population, it is not recommended in all patients with CKD and obesity. Our patients are best served by the expertise of a multidisciplinary team to evaluate all treatment options and formulate a plan that meets their goals."
For more information
Kukla A, et al. Weight loss surgery increases kidney transplant rates in patients with renal failure and obesity. Mayo Clinic Proceedings. 2024;99:705.
Refer a patient to Mayo Clinic.