Nutritional Management for Chronic Kidney Disease Patients who Undergo Bariatric Surgery: A Narrative Review

• Published in: Advances in nutrition (Bethesda, Md.) Vol. 10; no. 1; pp. 122 - 132
• Main Authors: Ben-Porat, Tair, Weiss-Sadan, Anat, Rottenstreich, Amihai, Sherf-Dagan, Shiri, Schweiger, Chaya, Yosef-Levi, Irit Mor, Weiner, Dana, Azulay, Odile, Sakran, Nasser, Harari, Rivki, Elazary, Ram
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2019; Oxford University Press
• Subjects: Adult; bariatric surgery; Bariatric Surgery - rehabilitation; chronic kidney disease; Dietary Supplements; Female; Humans; kidney transplantation; Male; Middle Aged; Nutrition Assessment; Nutrition Therapy - methods; nutritional care; Nutritional Status; Postoperative Period; Preoperative Period; Renal Insufficiency, Chronic - diet therapy; Renal Insufficiency, Chronic - surgery; Review; chronic kidney disease; nutritional status; bariatric surgery; PEW; RYGB; PTH; kidney transplantation; ESKD; IU; BS; GFR; SG; LBM; 25(OH)D; CKD; nutritional care
• ISSN: 2161-8313; 2156-5376; 2156-5376
• DOI: 10.1093/advances/nmy112

Bariatric surgery (BS) may be effective for chronic kidney disease (CKD) patients by reducing microalbuminuria and proteinuria, and by facilitating their meeting inclusion criteria for kidney transplantation. However, nutritional management for this population is complex and specific guidelines are scarce. A literature search was performed to create dietetic practice for these patients based on the most recent evidence. For the purposes of nutritional recommendations, we divided the patients into 2 subgroups: 1) patients with CKD and dialysis, and 2) patients after kidney transplantation. Before surgery, nutritional care includes nutritional status evaluation and adjusting doses of supplements to treat deficiencies and daily nutrient intake according to the dietary restrictions derived from kidney disease, including quantities of fluids, protein, phosphorus, potassium, and vitamins. After BS, these patients are at major risk for lean body mass loss, malnutrition and dehydration because of fluid restriction and diuretics. Postoperative nutritional recommendations should be carefully tailored according to CKD nutritional limitations and include specific considerations regarding protein, fluids, and supplementation, in particular calcium, vitamin A, and vitamin D. Nutritional management of CKD and kidney transplant patients undergoing BS is challenging and future studies are required to establish uniform high-level evidence-based guidelines.