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Kidney disease

Side effects high for kidney disease patients following surgery

further research to identify risk factors for harmful side effects and death, and for nonsurgical alternatives to help obese kidney disease patients lose weight

Kidney disease patients who undergo bariatric surgery can successfully lose weight, but many experience significant side effects, according to a study, “Safety and Efficacy of Bariatric Surgery in Obese Patients with CKD: The London Renal Obesity Network (LonRON) Experience", at American Society of Nephrology Kidney Week 2013, in Atlanta, GA.

Although bariatric surgery is currently the most effective treatment for obesity, recent evidence suggests the complication rate may be higher in those with chronic kidney disease than in those without. As a result, Helen MacLaughlin and colleagues from King's College London, UK, conducted a retrospective study of all obese patients with kidney disease who underwent laparoscopic bariatric surgery in three major London teaching hospitals from 2007 to 2012.

Data from 74 patients' medical records revealed that across all forms of surgery; 38% underwent Roux-en-Y bypass (RYGB), 57% sleeve gastrectomy and 5% adjustable gastric banding.

Eleven percent of patients were classified as CKD stages 1-2, 59% CKD stage 3, 12% CKD stage 4/stage. Eighteen percent of patients were on haemodialysis at the time of surgery.

Excess weight was lost in 61% of patients one year post-surgery. There were 16 adverse events, including two deaths (3%) related to surgical complications. Acute kidney injury was most frequent (4%), followed by leak (3%), acidosis and elevated blood potassium levels (3%), post-operative chest infection (3%), vitamin B12/iron deficiency (3%), fistula/graft failure (3%), and heart attacks (1%). An additional four deaths occurred during the study period, including two related to cancer.

"While bariatric surgery is effective for weight loss in obese patients with chronic kidney disease, the adverse event and mortality rates are high," the authors concluded. "Identification of risk factors for adverse events and investigation of non-surgical alternatives remain priorities."

The study authors called for further research to identify risk factors for harmful side effects and death, and for nonsurgical alternatives to help obese kidney disease patients lose weight.

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