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ABSTRACT
Year : 2018  |  Volume : 4  |  Issue : 4  |  Page : 109-110

Diet for bariatric surgery for obese patients with kidney disease


1 Head, Department of Minimal Access and Bariatric Surgery, Saifee Hospital, Mumbai, Maharashtra, India
2 Group Manager Clinical Practice, Nutrition and Patient Care, Dr. Muffi's Digestive Health Institute, Mumbai, Maharashtra, India

Date of Web Publication19-Sep-2019

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jrnm.jrnm_23_19

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How to cite this article:
Lakdawala M, Remidios C. Diet for bariatric surgery for obese patients with kidney disease. J Renal Nutr Metab 2018;4:109-10

How to cite this URL:
Lakdawala M, Remidios C. Diet for bariatric surgery for obese patients with kidney disease. J Renal Nutr Metab [serial online] 2018 [cited 2019 Oct 21];4:109-10. Available from: http://www.jrnm.in/text.asp?2018/4/4/109/267193



Obesity is a risk factor for the progression of chronic kidney disease (CKD),[1] and both proteinuria and microalbuminuria have been associated with obesity.[2]

Bariatric surgery is the only long-term solution for weight loss in obese individuals.

Prior to bariatric surgery, a 7–10-day preoperative diet is mandatory.

This diet essentially requires patients to go on a high-protein, low-carbohydrate diet which includes pproximately 1000 kcals/day and 75–80 g protein daily with plenty of low-calorie liquids.[3]

The preoperative diet is crucial as it helps to decrease the size liver, thereby reducing surgical time, blood loss, and damage to the liver. It also helps in preparing patients for diet restriction in the postoperative phase.

Those patients who have compromised renal function also need to follow the preoperative diet but will need close monitoring and a modified diet, in order not to exacerbate the existing condition.[4]

Laboratory investigations to look at:

  • Serum creatinine
  • Blood urea nitrogen (BUN)
  • Serum electrolytes
  • Total proteins and serum albumin
  • Hemoglobin and serum iron studies
  • Urinary creatinine clearance.


Protein requirement was approximately 0.8–1.2 g/kg IBW.[3],[4] However, protein requirements should be adjusted according to creatinine, albumin, and urinary creatinine clearance.

Electrolyte imbalances will need to be monitored, and the type of fluids recommended on the preoperative diet will need to be adjusted accordingly. Low-calorie liquids that are generally prescribed during the preoperative diet are usually potassium rich, for example, coconut water and clear soups. These fluids need to be restricted for renal compromised patients. Sodium restriction might also be required in some cases.

Fluid intake might also have to be adjusted in these patients and should be calculated previous 24-h urine output + 500 ml.

Hemoglobin and serum iron studies need to be evaluated presurgery; iron supplementation or erythropoietin will need to be administered based on these levels.

Patients with CKD Stage 1–3 rarely need dietary potassium, protein, phosphorus, or fluid restrictions; therefore, the nutritional management of the postbariatric surgery patient with mildly impaired renal function should follow existing postoperative protocols.[4]

Diet progression remains the same for renal compromised patients as with any other patient:

  • Day 1–2: clear liquids
  • Day 3–15: full liquids
  • Day 16–30 semi-solids
  • Day 30 onward: full diet.


Postoperatively, oral intake drops drastically, and hence, it is critical that patients are adequately hydrated once intravenous (IV) fluids are discontinued.

Although it is difficult for patients to meet the fluid requirement postoperative fluid intake should not fall below 1000 ml, IV fluids might need to be continued until patients meet this minimum requirement.

Protein intake should not be severely restricted postoperative and be maintained at 0.8–1.2 g/kg/IBW.

Protein supplementation should resume on postoperative day 3, and a renal specific supplement should be considered in order to maintain the serum electrolyte balance.

Other nutrient supplementations will continue as per baseline reports, namely multivitamins, calcium, iron, Vitamin B12, and Vitamin D3.

Serum creatinine, BUN, and serum electrolyte should be monitored closely in the immediate postoperative phase up to 3 months postoperative.



 
  References Top

1.
Afshinnia F, Wilt TJ, Duval S, Esmaeili A, Ibrahim HN. Weight loss and proteinuria: Systematic review of clinical trials and comparative cohorts. Nephrol Dial Transplant 2010;25:1173-83.  Back to cited text no. 1
    
2.
Rosenstock JL, Pommier M, Stoffels G, Patel S, Michelis MF. Prevalence of proteinuria and albuminuria in an obese population and associated risk factors. Front Med (Lausanne) 2018;5:122.  Back to cited text no. 2
    
3.
Remedios C, Bhasker AG, Dhulla N, Dhar S, Lakdawala M. Bariatric nutrition guidelines for the Indian population. Obes Surg 2016;26:1057-68.  Back to cited text no. 3
    
4.
Lambert K, Beer J, Dumont R, Hewitt K, Manley K, Meade A, et al. Weight management strategies for those with chronic kidney disease: A consensus report from the Asia Pacific Society of Nephrology and Australia and New Zealand Society of Nephrology 2016 renal dietitians meeting. Nephrology (Carlton) 2018;23:912-20.  Back to cited text no. 4
    




 

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