A fact in following Peritoneal Dialysis patients is most will pursue a kidney transplant. Another truth is that as many as 30-50% will initially be above the BMI limit set for them by the Transplant Team. Of this group given a specific amount of weight to lose, in our experience, less than 25% will accomplish this task, and usually that is when the amount required to lose was fairly minor to begin with. And we acknowledge when you combine PD, working, family demands, the fact you are tired to begin with, and a constant belly full of sugar, not to mention sometimes protein losses, it is hard to lose significant amounts of weight. All the while, you are remaining on dialysis, are not listed and your time is not going toward being on a list.
We also realize a shorter interval between initiation of dialysis and transplant is the most successful in terms of physical side effects of dialysis and long term transplant outcome.
With this in mind, we have begun to recommend surgical weight loss surgery in patients who are significantly obese but otherwise transplant suitable, on PD, and desirous of a transplant. At this point, 4 have had such surgery-3 gastric bypass, one gastric banding. The 3 most recent had no interuption of their peritoneal dialysis.(The 4th had the surgery done before dialysis began). All 4 have done well, with the weight loss less dramatic with the banding, although it has been steady. 2 of the patients met their weight loss goal for transplant in the first 2 months after surgery.
1 person has been listed. 2 are pending re-evaluation since surgery by the transplant team(all done recently) and the 4th is very close to weight goal. All 4 had no significant post operative complications.
Based on this, I have begun to recommend evaluation for several more of the patients who are obese and therefore not listed in the large PD group I follow. As for that, patients waiting in the same clinic waiting room for month after month tend to know each other and their respective stories. Once the patients see the patient who has had the weight loss surgery feeling and looking good, actively pursuing transplant now, the idea of being evaluated for this surgery(we send them to the same medical center-University of Miami-that does most of our kidney transplants),sells itself.
Stayed tuned for how it evolves.
