Applying Enhanced Recovery After Bariatric Surgery (ERABS) Protocol for Morbidly Obese Patients With End-Stage Renal Failure

Abstract

Background In 2015 our hospital implemented the ERABS protocol. From that moment also morbidly obese patients with endstage renal disease (ESRD) were enrolled. The objective of this study was to evaluate the potential benefits and safety of the ERABS protocol for ESRD morbidly obese patients compared with patients who are morbidly obese patients undergoing bariatric surgery. Methods A retrospective review of a prospectively collected database was conducted for ESRD patients who underwent bariatric surgery according to the ERABS protocol. The primary endpoint was the length of hospital stay in days. Secondary endpoints were the number of re-admissions, re-operations, length of renal replacement therapy, and complications during admission and within 30 days after surgery. Propensity score matching was used to compare groups. Results From 2015 onward 1199 non-ESRD patients and 21 with ESRD were operated. Propensity score matching resulted in two groups of 19 patients. In terms of comorbidities, both groups presented typical components of metabolic syndrome. In the ESRD group, one patient had serious complications (rated as Clavien-Dindo IIIb and IVb) at the first postoperative day after OAGB. The overall complication rate was comparable and not significantly different compared with the non-ESRD group. Conclusion Our study shows that ERAS in this population has overall minimal adverse events and lack of any ERAS-related complications.

Weight Loss After Bariatric Surgery in Morbidly Obese End-Stage Kidney Disease Patients as Preparation for Kidney Transplantation. Matched Pair Analysis in a High-Volume Bariatric and Transplant Center

“…However, often due to obesityassociated comorbidities, their access to the transplant list and transplantation is inferior to non-obese [5,33]. Bariatric surgery is considered as a safe method of obesity treatment in that specific group of patients and feasible as a bridge therapy to kidney transplantation [6,[34][35][36]. Additionally, weight loss after bariatric surgery may improve kidney function to an acceptable level and delay the qualification to dialysis therapy in patients undergoing bariatric surgery before ESKD development.…”

“…It was proven that obesity limits, or at least delays, access to kidney transplantation [5]. Bariatric surgery is considered a safe method to achieve rapid and sustainable weight loss before kidney transplantation [6]. Pretransplant weight loss may allow to sustain body weight and prevent common posttransplant weight gain [7].…”

Intensive management of obesity in people with severe chronic kidney disease: A review

“…Study search and selection for very-low-energy diet (VLED) studies were higher in another three. 30,35,37 Of these, there was no increased complication risk in studies in which patients were matched for baseline co-morbidities, 21,40 but an increased risk in studies where the ESKD population had higher baseline co-morbidities, 30,35,37 with pulmonary complications, 30,37 infections 37 and cardiac arrest 30 more commonly reported, although overall events were low. Laparoscopic Roux-en-Y gastric bypass was associated with a higher complication rate than SG or AGB in one retrospective electronic database analysis.…”

“…Outcomes following sleeve gastrectomy (SG) were reported in 20 studies, 20,21,23,24,26,[28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] gastric bypass (GB) in 17 studies, [19][20][21][22][23][24][25][27][28][29][30]33,[35][36][37]41,42 adjustable gastric banding (AGB) in 10 studies, [20][21][22][23][27][28][29][30]33,41 and duodenal switch in two studies. 22,41 Fifteen studies reported on multiple bariatric surgery techniques.…”

“…22,41 Fifteen studies reported on multiple bariatric surgery techniques. [20][21][22][23][24][27][28][29][30]33,[35][36][37]41,42 Overall complication rates were low, although there was variability among studies (Table 5). Complication rates in people with ESKD did not differ from the control population in three studies, 21,23,40 but…”