Conclusions

In patients with CKD or ESRD, weight loss surgery can certainly add
complexity to care following surgery. For that reason, careful consideration
of the type of procedure recommended for these patients is warranted.
Careful and frequent monitoring by a dietitian can help patients improve or
maintain nutritional status, prevent deficiencies, and avoid toxicities.

Although the sleeve gastrectomy surgery is not universally covered by
third-party payers, it may be a good choice for patients who plan to have a
kidney or organ transplant after achieving desired weight loss. Weight loss
results to date do seem to be comparable to standard gastric bypass.
Although, not promoted as a malabsorptive procedure, there still may be
differences in absorption of nutrients and medications following sleeve gastrectomy. Resolution of diabetes is reportedly similar to that of
RYGB.

AGB may be a good option for highly motivated patients; however,
complications may still occur. Long-term issues include erosion of stomach,
band slippage, and need for esophageal dilatation. These can all result in
band removal or require additional surgery. Food intolerances can also
occur and have been a major reason for subsequent band removal.Weight
loss results for AGB are reportedly less than gastric bypass at one year
post-surgery. So, for patients seeking weight loss to qualify as a
transplant candidate, consideration for rate of weight loss may be a
deciding factor in the choice of the different weight loss surgery procedures.

RYGB remains the most common weight loss procedure done today. It is
becoming more cost effective, and, over the past decade, post-surgical
complications appear to be declining.

Regardless of the type of weight loss procedure done, careful monitoring for
nutrient deficiencies is needed. Medication adjustments may be required
immediately following surgery and also over time. Ideally, a standard
vitamin and mineral regimen for post-weight loss surgery with patients who
have CKD or ESRD is desired. Yet, even with a standard recommended regimen,
monitoring for deficiencies and toxicities over time seems prudent in all
patients following weight loss surgical procedures.