Obesity Management Guide in Kidney Transplantation Patients in European Kidney Association!

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Obesity Management Guide in Kidney Transplantation Patients in European Kidney Association!

2021-11-27 00:06:25 25 ℃

In November 2021, the European Kidney Association (ERA) Working Group issued the management guidelines for kidney transplant candidates and obesity to guide the development of the final nephropathy (ESKD) and obese patients' management decisions. This guide includes risk layers, prognostic predictions, patient screening, and weight loss surgery.

one

Risk stratification

Suggest:

When the kidney transplantation is evaluated, the waist or waist hip ratio (2C) should be measured in addition to the body mass index (BMI).

Detailed explanation:

1. BMI defined obesity is ≥30kg / m2, and can be divided into level 1 obesity (30-34kg / m2), level 2 obesity (35-39 kg / m2) and level 3 obesity (≥40 kg / m2).

2. Waist Measurement can help physicians understand whether the patient is abdominal obesity (defined as male waist> 102cm, female waist> 88cm).

3. Abdominal obese waist and hip ratio is usually: male waist button ratio> 0.90, female waist hip ratio> 0.85.

two

Prognostic prediction

Suggest:

1. BMI ESKD patients in 30-34kg / m2 can accept kidney transplantation (2C);

2. There is not enough clinical evidence to support higher BMI (≥ 35) patients (D);

3. Mission on obese ESKD patients, clarifying the risk of perioperative complications, including but not limited to graft function recovery delays, traumatic complications, acute risotics, diabetes (1C).

In addition, when discussing whether kidney transplantation is discussed, other risk factors of patients should be detailed.

three

Patient screening

Suggest:

1. For patients with ESKDs from 30-39.9kg / m2, if the patient is suitable for renal transplant surgery, then renal transplantation is the best treatment, regardless of whether the donor dies (2C);

2. For patients with ESKD in BMI at 30-39kg / m2, do not delay the kidney transplantation time (2C) only because of the increase in patient BMI.

Four

Weight loss surgery

01

Kidney transplantation surgery

Suggest:

Encourage patients with kidney transplant with obesity to lose weight, and supervise (1D) by multidisciplinary weight management team;

For patients with kidney transplantation of BMI ≥ 40kg / m2, weight loss surgery is a treatment for consideration (2C);

For patients with kidney transplantation of BMI ≥ 35kg / m2, weight loss surgery will improve at least one merger (2D) related to obesity (2D);

For patients with kidney transplantation, the laparoscopic cuff stomach is superior to other weight loss surgery (2D).

add:

The usual population of weight loss surgical indications are between BMI ≥ 40kg / m2 or BMI between 35-39kg / m2, and at least one complications related to obesity, such as type 2 diabetes, sleep apnea syndrome, non-alcoholic fat Liver or heart disease.

02

Renal transplantation surgery

For patients after renal transplant surgery, 2-4 recommendations before renal transplantation were consistent.

add:

For patients after renal transplantation, the preferred non-surgical method for weight loss, if it is not possible to reach or maintain the weight loss target, weight loss surgery should be considered.

Although most chronic kidney disease and ESKD patients are related to malnutrition. However, some patients have more obesity. Existing studies have shown that obesity increases the risk of cardiovascular, metabolism and surgical complications in patients with kidney transplantation. Therefore, how to effectively assess whether obese patients can accept kidney transplantation. This recommendation can help medical workers better assess whether the obese ESKD population can kidney transplantation or weight loss surgery.

references:

1.Oniscu GC, Abramowicz D, Bolignano D, et al Management ofobesity in kidney transplant candidates and recipients:. A clinical practiceguideline by the Descartes working group of ERA Nephrol Dial Transplant 2021Nov 12:.. Gfab310.