Bariatric Surgery in Chronic Kidney Disease: Safety, Efficacy and Nutritional Considerations
DOI:
https://doi.org/10.71749/pkj.142Keywords:
Bariatric Surgery, Obesity, Kidney Transplantation, Nutritional Requirements, Renal Insufficiency, ChronicAbstract
The prevalence of obesity has increased, and simultaneously, there has been an increase in the prevalence of chronic kidney disease. Obesity is considered an independent risk factor for the incidence and progression of chronic kidney disease and is also associated with an increased risk of type 2 diabetes and hypertension, which are major causes of chronic kidney disease. Therefore, it is essential to prevent and treat obesity to reduce the incidence of chronic kidney disease and delay of its progression. Given the failure of weight loss through lifestyle modification, the hypothesis arises to submit chronic kidney patients with morbid obesity to bariatric surgery. However, considering the specific nutritional requirements of chronic kidney patients, doubts arise about the universal application of current guidelines for patients undergoing bariatric surgery. Thus, the present review aims to assess the safety and efficacy of bariatric surgery in the different stages of chronic kidney disease and the nutritional requirements of chronic kidney patients undergoing bariatric surgery. Through this review, it is possible to conclude that bariatric surgery can be considered for chronic kidney and transplant patients who fail in losing weight through other approaches. However, it is emphasized that randomized clinical trials and the development of guidelines are necessary to ensure proper nutritional management of chronic kidney and transplant patients undergoing bariatric surgery.
Downloads
References
World Health Organisation. Age-standardised prevalence of obesity among adults (18+ years) [cited 2024 Apr 26]. Available from: https://data.who.int/indicators/i/C6262EC/BEFA58B
World Obesity Federation. World Obesity Atlas 2023. [cited 2024 Nov 4]. Available from: https://data.worldobesity.org/publications/?cat=19
Vinhas J, Aires I, Batista C, Branco P, Brandao J, Nogueira R, et al. RENA Study: Cross-Sectional Study to Evaluate CKD Prevalence in Portugal. Nephron. 2020;144:479-87. doi: 10.1159/000508678
Pippias M, Kramer A, Noordzij M, Afentakis N, Alonso de la Torre R, Ambuhl PM, et al. The European renal association-European dialysis and transplant association registry annual report 2014: a summary. Clin Kidney J. 2017;10:154-69. doi: 10.1093/ckj/sfw135
Boerstra BA, Boenink R, Astley ME, Bonthuis M, Abd ElHafeez S, Arribas Monzon F, et al. The ERA Registry Annual Report 2021: a summary. Clin Kidney J. 2024;17:sfad281. doi: 10.1093/ckj/sfad281
Apovian CM. Obesity: definition, comorbidities, causes, and burden. Am J Manag Care. 2016;22:s176-85.
Jha V, Garcia-Garcia G, Iseki K, Li Z, Naicker S, Plattner B, et al. Chronic kidney disease: global dimension and perspectives. Lancet. 2013;382:260-72. doi: 10.1016/S0140-6736(13)60687-X
Hojs R, Ekart R, Bevec S, Vodošek Hojs N. Chronic Kidney Disease and Obesity. Nephron. 2023;147:660-64. doi: 10.1159/000531379
Garofalo C, Borrelli S, Minutolo R, Chiodini P, De Nicola L, Conte G. A systematic review and meta-analysis suggests obesity predicts onset of chronic kidney disease in the general population. Kidney Int. 2017;91:1224-35. doi: 10.1016/j.kint.2016.12.013
Chintam K, Chang AR. Strategies to Treat Obesity in Patients With CKD. Am J Kidney Dis. 2021;77:427-39. doi: 10.1053/j.ajkd.2020.08.016
Hsu CY, Iribarren C, McCulloch CE, Darbinian J, Go AS. Risk factors for end-stage renal disease: 25-year follow-up. Arch Intern Med. 2009;169:342-50. doi: 10.1001/archinternmed.2008.605
D'Agati VD, Chagnac A, de Vries AP, Levi M, Porrini E, Herman-Edelstein M, Praga M. Obesity-related glomerulopathy: clinical and pathologic characteristics and pathogenesis. Nat Rev Nephrol. 2016;12:453-71. doi: 10.1038/nrneph.2016.75
Zhu Q, Scherer PE. Immunologic and endocrine functions of adipose tissue: implications for kidney disease. Nat Rev Nephrol. 2018;14:105-20. doi: 10.1038/nrneph.2017.157
Martinez-Garcia C, Izquierdo-Lahuerta A, Vivas Y, Velasco I, Yeo TK, Chen S, et al. Renal Lipotoxicity-Associated Inflammation and Insulin Resistance Affects Actin Cytoskeleton Organisation in Podocytes. PLoS One. 2015;10:e0142291. doi: 10.1371/journal.pone.0142291
Lee BT, Ahmed FA, Hamm LL, Teran FJ, Chen CS, Liu Y, et al. Association of C-reactive protein, tumour necrosis factor-alpha, and interleukin-6 with chronic kidney disease. BMC Nephrol. 2015;16:77. doi: 10.1186/s12882-015-0068-7
Ix JH, Sharma K. Mechanisms linking obesity, chronic kidney disease, and fatty liver disease: the roles of fetuin-A, adiponectin, and AMPK. J Am Soc Nephrol. 2010;21:406-12. doi: 10.1681/ASN.2009080820
Briffa JF, McAinch AJ, Poronnik P, Hryciw DH. Adipokines as a link between obesity and chronic kidney disease. Am J Physiol Renal Physiol. 2013;305:F1629-36. doi: 10.1152/ajprenal.00263.2013
Sharma K, Ramachandrarao S, Qiu G, Usui HK, Zhu Y, Dunn SR, et al. Adiponectin regulates albuminuria and podocyte function in mice. J Clin Invest. 2008;118:1645-56. doi: 10.1172/JCI32691
Ohashi K, Iwatani H, Kihara S, Nakagawa Y, Komura N, Fujita K, et al. Exacerbation of albuminuria and renal fibrosis in subtotal renal ablation model of adiponectin-knockout mice. Arterioscler Thromb Vasc Biol. 2007;27:1910-7. doi: 10.1161/ATVBAHA.107.147645
Sarafidis PA, Ruilope LM. Insulin resistance, hyperinsulinemia, and renal injury: mechanisms and implications. Am J Nephrol. 2006;26:232-44. doi: 10.1159/000093632
Varela JE, Hinojosa M, Nguyen N. Correlations between intra-abdominal pressure and obesity-related co-morbidities. Surg Obes Relat Dis. 2009;5:524-34.8. doi: 10.1016/j.soard.2009.04.003
Alicic RZ, Patakoti R, Tuttle KR. Direct and indirect effects of obesity on the kidney. Adv Chronic Kidney Dis. 2013;20:121-7. doi: 10.1053/j.ackd.2012.12.006
Redon J, Lurbe E. The kidney in obesity. Curr Hypertens Rep. 2015;17:555. doi: 10.1007/s11906-015-0555-z
Chen J-Y, Hsu T-W, Liu J-H, Pan H-C, Lai C-F, Yang S-Y, Wu V-C. Kidney and cardiovascular outcomes among patients with CKD receiving GLP-1 receptor agonists: a systematic review and meta-analysis of randomized trials. Am J Kidney Dis. 2025;85:555-69. e1. doi: 10.1053/j.ajkd.2024.11.013
Kelly M, Lewis J, Rao H, Carter J, Portillo I, Beuttler R. Effects of GLP-1 receptor agonists on cardiovascular outcomes in patients with type 2 diabetes and chronic kidney disease: A systematic review and meta-analysis. Pharmacotherapy. 2022;42:921-8. doi: 10.1002/phar.2737
Wong HJ, Sim B, Teo YH, Teo YN, Chan MY, Yeo LL, et al. Efficacy of GLP-1 receptor agonists on weight loss, BMI, and waist circumference for patients with obesity or overweight: a systematic review, meta-analysis, and meta-regression of 47 randomized controlled trials. Diabetes Care. 2025;48:292-300. doi: 10.2337/dc24-1678
Colhoun HM, Lingvay I, Brown PM, Deanfield J, Brown-Frandsen K, Kahn SE, et al. Long-term kidney outcomes of semaglutide in obesity and cardiovascular disease in the SELECT trial. Nature Med. 2024;30:2058-66. doi: 10.1038/s41591-024-03015-5
Delgado LM, Barone G, Garcia G, Pilon G, Viana P, Marques FILCB, et al. Metabolic Bariatric Surgery versus GLP-1 Receptor Agonists for Obesity Management: A Systematic Review and Meta-Analysis. Obes Surg. 2026 (in press). doi: 10.1007/s11695-026-08551-2
Sabatella L, Ortega PM, Azcarate VV, Sastre FR, Pagola AU, Ahmed A, et al. Comparative Efficacy of Metabolic/Bariatric Surgery Versus GLP-1 Receptor Agonists: A Network Meta-Analysis of Randomized Controlled Trials. Obesity. 2026;34:770-81. doi: 10.1002/oby.70100
Arterburn DE, Telem DA, Kushner RF, Courcoulas AP. Benefits and Risks of Bariatric Surgery in Adults: A Review. JAMA. 2020;324:879-87. doi: 10.1001/jama.2020.12567
Oniscu GC, Abramowicz D, Bolignano D, Gandolfini I, Hellemans R, Maggiore U, et al. Management of obesity in kidney transplant candidates and recipients: A clinical practice guideline by the DESCARTES Working Group of ERA. Nephrol Dial Transplant. 2021;37:i1-i15. doi: 10.1093/ndt/gfab310
American Society for Metabolic and Bariatric Surgery. Bariatric Surgery Procedures [cited 2024 May 31]. Available from: https://asmbs.org/patients/bariatric-surgery-procedures/
Alothman S, Cornejo J, Adrales G, Li C, Sebastian R. Comparative outcomes of bariatric surgery in patients with ESRD on dialysis in the modern era of renal transplantation: analysis using the 2015-2020 MBSAQIP database. Surg Endosc. 2023;37:7106-13. doi: 10.1007/s00464-023-10200-z
Navarro-Diaz M, Serra A, Romero R, Bonet J, Bayés B, Homs M, et al. Effect of drastic weight loss after bariatric surgery on renal parameters in extremely obese patients: long-term follow-up. J Am Soc Nephrol. 2006;17:S213-7. doi: 10.1681/ASN.2006080917
Chang AR, Chen Y, Still C, Wood GC, Kirchner HL, Lewis M, et al. Bariatric surgery is associated with improvement in kidney outcomes. Kidney Int. 2016;90:164-71. doi: 10.1016/j.kint.2016.02.039
Li K, Zou J, Ye Z, Di J, Han X, Zhang H, et al. Effects of Bariatric Surgery on Renal Function in Obese Patients: A Systematic Review and Meta Analysis. PLoS One. 2016;11:e0163907. doi: 10.1371/journal.pone.0163907
Bilha SC, Nistor I, Nedelcu A, Kanbay M, Scripcariu V, Timofte D, et al. The Effects of Bariatric Surgery on Renal Outcomes: a Systematic Review and Meta-analysis. Obes Surg. 2018;28:3815-33. doi: 10.1007/s11695-018-3416-4
Turgeon NA, Perez S, Mondestin M, Davis SS, Lin E, Tata S, et al. The impact of renal function on outcomes of bariatric surgery. J Am Soc Nephrol. 2012;23:885-94. doi: 10.1681/ASN.2011050476
Friedman AN. Implications and management of obesity in kidney disease. In: Byham-Gray L, Burrowes J, Chertow G, editors. Nutrition in Kidney Disease. Nutrition and Health. Totowa: Humana Press; 2013. p. 147-169.
Scheurlen KM, Probst P, Kopf S, Nawroth PP, Billeter AT, Müller-Stich BP. Metabolic surgery improves renal injury independent of weight loss: a meta-analysis. Surg Obes Relat Dis. 2019;15:1006-20. doi: 10.1016/j.soard.2019.03.013
Stein EM, Silverberg SJ. Bone loss after bariatric surgery: causes, consequences, and management. Lancet Diabetes Endocrinol. 2014;2:165-74. doi: 10.1016/S2213-8587(13)70183-9
Moize V, Andreu A, Rodriguez L, Flores L, Ibarzabal A, Lacy A, et al. Protein intake and lean tissue mass retention following bariatric surgery. Clin Nutr. 2013;32:550-5. doi: 10.1016/j.clnu.2012.11.007
Lieske JC, Mehta RA, Milliner DS, Rule AD, Bergstralh EJ, Sarr MG. Kidney stones are common after bariatric surgery. Kidney Int. 2015;87:839-45. doi: 10.34067/KID.0004982020
Upala S, Jaruvongvanich V, Sanguankeo A. Risk of nephrolithiasis, hyperoxaluria, and calcium oxalate supersaturation increased after Roux-en-Y gastric bypass surgery: a systematic review and meta-analysis. Surg Obes Relat Dis. 2016;12:1513-21. doi: 10.1016/j.soard.2016.04.004
Molnar MZ, Streja E, Kovesdy CP, Bunnapradist S, Sampaio MS, Jing J, et al. Associations of body mass index and weight loss with mortality in transplant-waitlisted maintenance haemodialysis patients. Am J Transplant. 2011;11:725-36. doi: 10.1111/j.1600-6143.2011.03468.x
Kalantar-Zadeh K, Streja E, Molnar MZ, Lukowsky LR, Krishnan M, Kovesdy CP, Greenland S. Mortality prediction by surrogates of body composition: an examination of the obesity paradox in haemodialysis patients using composite ranking score analysis. Am J Epidemiol. 2012;175:793-803. doi: 10.1093/aje/kwr384
Kalantar-Zadeh K, Streja E, Kovesdy CP, Oreopoulos A, Noori N, Jing J, et al. The obesity paradox and mortality associated with surrogates of body size and muscle mass in patients receiving haemodialysis. Mayo Clin Proc. 2010;85:991-1001. doi: 10.4065/mcp.2010.0336
Postorino M, Marino C, Tripepi G, Zoccali C. Abdominal obesity and all-cause and cardiovascular mortality in end-stage renal disease. J Am Coll Cardiol. 2009;53:1265-72. doi: 10.1016/j.jacc.2008.12.040
Fox CS, Massaro JM, Hoffmann U, Pou KM, Maurovich-Horvat P, Liu CY, et al. Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study. Circulation. 2007;116:39-48. doi: 10.1161/CIRCULATIONAHA.106.675355
Okamoto T, Morimoto S, Ikenoue T, Furumatsu Y, Ichihara A. Visceral fat level is an independent risk factor for cardiovascular mortality in haemodialysis patients. Am J Nephrol. 2014;39:122-9. doi: 10.1159/000358335
Ramkumar N, Pappas LM, Beddhu S. Effect of body size and body composition on survival in peritoneal dialysis patients. Perit Dial Int. 2005;25:461-9.
Quero M, Comas J, Arcos E, Hueso M, Sandoval D, Montero N, et al. Impact of obesity on the evolution of outcomes in peritoneal dialysis patients. Clin Kidney J. 2021;14:969-82. doi: 10.1093/ckj/sfaa055
Ahmadi SF, Zahmatkesh G, Streja E, Mehrotra R, Rhee CM, Kovesdy CP, et al. Association of Body Mass Index With Mortality in Peritoneal Dialysis Patients: A Systematic Review and Meta-Analysis. Perit Dial Int. 2016;36:315-25. doi: 10.3747/pdi.2015.00052
Choy AS, Chow KM, Kwan BC, Cheng PM, Kwong VW, Pang WF, et al. Weight change during the first year of peritoneal dialysis: Risk factors and prognostic implications. Hong Kong J Nephrol. 2015;17:28-35. doi: 10.1016/j.hkjn.2015.08.001
Obi Y, Streja E, Mehrotra R, Rivara MB, Rhee CM, Soohoo M, et al. Impact of Obesity on Modality Longevity, Residual Kidney Function, Peritonitis, and Survival Among Incident Peritoneal Dialysis Patients. Am J Kidney Dis. 2018;71:802-13. doi: 10.1053/j.ajkd.2017.09.010
Ng JK, Than WH, Szeto CC. Obesity, Weight Gain, and Fluid Overload in Peritoneal Dialysis. Front Nephrol. 2022;2:880097. doi: 10.3389/fneph.2022.880097
Dziodzio T, Hillebrandt KH, Knitter S, Nösser M, Globke B, Ritschl PV, et al. Body Mass Index Thresholds and the Use of Bariatric Surgery in the Field of Kidney Transplantation in Germany. Obes Surg. 2022;32:1641-48. doi: 10.1007/s11695-022-06000-4
Lassalle M, Fezeu LK, Couchoud C, Hannedouche T, Massy ZA, Czernichow S. Obesity and access to kidney transplantation in patients starting dialysis: A prospective cohort study. PLoS One. 2017;12:e0176616. doi: 10.1371/journal.pone.0176616
Bosch KD, Harrington C, Sulutaura L, Lacea E, Burton K, Fernandez-Munoz N, et al. Bariatric Surgery as a Bridge to Facilitate Renal Transplantation in Patients with End-Stage Renal Disease. Obes Surg. 2024;34:355-62. doi: 10.1007/s11695-023-06985-6
Cohen JB, Lim MA, Tewksbury CM, Torres-Landa S, Trofe-Clark J, Abt PL, et al. Bariatric surgery before and after kidney transplantation: long-term weight loss and allograft outcomes. Surg Obes Relat Dis. 2019;15:935-41. doi: 10.1016/j.soard.2019.04.002
Fernando S, Varma J, Dengu F, Menon V, Malik S, O'Callaghan J. Bariatric surgery improves access to renal transplantation and is safe in renal failure as well as after transplantation: A systematic review and meta-analysis. Transplant Rev. 2023;37:100777. doi: 10.1016/j.trre.2023.100777
Ku E, McCulloch CE, Roll GR, Posselt A, Grimes BA, Johansen KL. Bariatric surgery prior to transplantation and risk of early hospital re-admission, graft failure, or death following kidney transplantation. Am J Transplant. 2021;21:3750-57. doi: 10.1111/ajt.16779
Kim Y, Jung AD, Dhar VK, Tadros JS, Schauer DP, Smith EP, et al. Laparoscopic sleeve gastrectomy improves renal transplant candidacy and posttransplant outcomes in morbidly obese patients. Am J Transplant. 2018;18:410-16. doi: 10.1111/ajt.14463
Kassam AF, Mirza A, Kim Y, Hanseman D, Woodle ES, Quillin RC, 3rd, et al. Long-term outcomes in patients with obesity and renal disease after sleeve gastrectomy. Am J Transplant. 2020;20:422-29. doi: 10.1111/ajt.15650
Cohen JB, Tewksbury CM, Torres Landa S, Williams NN, Dumon KR. National postoperative bariatric surgery outcomes in patients with chronic kidney disease and end-stage kidney disease. Obes Surg. 2019;29:975-82. doi: 10.1007/s11695-018-3604-2
Palamuthusingam D, Singh A, Palamuthusingam P, Hawley CM, Pascoe EM, Johnson DW, Fahim M. Postoperative outcomes after bariatric surgery in patients on chronic dialysis: A systematic review and meta-analysis. Obes Res Clin Pract. 2021;15:473-84. doi: 10.1016/j.orcp.2021.06.010
Jamal MH, Corcelles R, Daigle CR, Rogula T, Kroh M, Schauer PR, Brethauer SA. Safety and effectiveness of bariatric surgery in dialysis patients and kidney transplant candidates. Surg Obes Relat Dis. 2015;11:419-23. doi: 10.1016/j.soard.2014.09.022
Hoogeveen EK, Aalten J, Rothman KJ, Roodnat JI, Mallat MJ, Borm G, et al. Effect of obesity on the outcome of kidney transplantation: a 20-year follow-up. Transplantation. 2011;91:869-74. doi: 10.1097/TP.0b013e3182100f3a
Heng AE, Montaurier C, Cano N, Caillot N, Blot A, Meunier N, et al. Energy expenditure, spontaneous physical activity and with weight gain in kidney transplant recipients. Clin Nutr. 2015;34:457-64. doi: 10.1016/j.clnu.2014.05.003
Tarsitano MG, Porchetti G, Caldara R, Secchi A, Conte C. Obesity and Lifestyle Habits among Kidney Transplant Recipients. Nutrients. 2022;14:2892. doi: 10.3390/nu14142892
de Oliveira CM, Moura A E, Gonçalves L, Pinheiro LS, Pinheiro FM, Jr., Esmeraldo RM. Post-transplantation weight gain: prevalence and the impact of steroid-free therapy. Transplant Proc. 2014;46:1735-40. doi: 10.1016/j.transproceed.2014.05.027
Bosma RJ, Kwakernaak AJ, van der Heide JJ, de Jong PE, Navis GJ. Body mass index and glomerular hyperfiltration in renal transplant recipients: cross-sectional analysis and long-term impact. Am J Transplant. 2007;7:645-52. doi: 10.1111/j.1600-6143.2006.01672.x
Ahmadi SF, Zahmatkesh G, Streja E, Molnar MZ, Rhee CM, Kovesdy CP, et al. Body mass index and mortality in kidney transplant recipients: a systematic review and meta-analysis. Am J Nephrol. 2014;40:315-24. doi: 10.1159/000367812
Lentine KL, Xiao H, Brennan DC, Schnitzler MA, Villines TC, Abbott KC, et al. The impact of kidney transplantation on heart failure risk varies with candidate body mass index. Am Heart J. 2009;158:972-82. doi: 10.1016/j.ahj.2009.10.009
Hill CJ, Courtney AE, Cardwell CR, Maxwell AP, Lucarelli G, Veroux M, et al. Recipient obesity and outcomes after kidney transplantation: a systematic review and meta-analysis. Nephrol Dial Transplant. 2015;30:1403-11. doi: 10.1093/ndt/gfv214
Gill JS, Lan J, Dong J, Rose C, Hendren E, Johnston O, Gill J. The survival benefit of kidney transplantation in obese patients. Am J Transplant. 2013;13:2083-90. doi: 10.1111/ajt.12331
Yemini R, Nesher E, Winkler J, Carmeli I, Azran C, Ben David M, et al. Bariatric surgery in solid organ transplant patients: Long-term follow-up results of outcome, safety, and effect on immunosuppression. Am J Transplant. 2018;18:2772-80. doi: 10.1111/ajt.14739
Pané A, Molina-Andujar A, Olbeyra R, Romano-Andironi B, Boswell L, Montagud-Marrahi E, et al. Bariatric Surgery Outcomes in Patients with Kidney Transplantation. J Clin Med. 2022;11:6030. doi: 10.3390/jcm11206030
Guggino J, Coumes S, Wion N, Reche F, Arvieux C, Borel AL. Effectiveness and Safety of Bariatric Surgery in Patients with End-Stage Chronic Kidney Disease or Kidney Transplant. Obesity. 2020;28:2290-304. doi: 10.1002/oby.23001
Montgomery JR, Cohen JA, Brown CS, Sheetz KH, Chao GF, Waits SA, Telem DA. Perioperative risks of bariatric surgery among patients with and without history of solid organ transplant. Am J Transplant. 2020;20:2530-39. doi: 10.1111/ajt.15883
Fagenson AM, Mazzei MM, Zhao H, Lu X, Edwards MA. Bariatric Surgery Outcomes in Patients with Prior Solid Organ Transplantation: an MBSAQIP Analysis. Obes Surg. 2020;30:2313-24. doi: 10.1007/s11695-020-04490-8
Golomb I, Winkler J, Ben-Yakov A, Benitez CC, Keidar A. Laparoscopic sleeve gastrectomy as a weight reduction strategy in obese patients after kidney transplantation. Am J Transplant. 2014;14(10):2384-90. doi: 10.1111/ajt.12829
Chan G, Hajjar R, Boutin L, Garneau PY, Pichette V, Lafrance JP, et al. Prospective study of the changes in pharmacokinetics of immunosuppressive medications after laparoscopic sleeve gastrectomy. Am J Transplant. 2020;20:582-88. doi: 10.1111/ajt.15602
Helfer J, Dang J, Modasi A, Switzer N, Birch DW, Karmali S. Effects of chronic corticosteroid and immunosuppressant use in patients undergoing bariatric surgery. Obes Surg. 2019;29:3309-15. doi: 10.1007/s11695-019-03995-1
Waldman G, Clark JE, Rogers CC, Gerlach A, Coglianese E, Ton V. Tacrolimus Level Variability in Setting of Gastric Sleeve. J Heart Lung Transplant. 2021;40:S486-S87. doi: 10.1016/j.healun.2021.01.1998
Mechanick IJ, Apovian C, Brethauer S, Garvey WT, Joffe AM, Kim J, et al. Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures - 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, the Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists- Executive Summary. Endocr Pract. 2019;25:1346-59. doi: 10.4158/GL-2019-0406
Ikizler TA, Burrowes JD, Byham-Gray LD, Campbell KL, Carrero JJ, Chan W, et al. KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update. Am J Kidney Dis. 2020;76:S1-107. doi: 10.1053/j.ajkd.2020.05.006
Potrykus M, Czaja-Stolic S, Malgorzewicz S, Proczko-Stepaniak M, Debska-Slizien A. Diet Management of Patients with Chronic Kidney Disease in Bariatric Surgery. Nutrients. 2022;15:165. doi: 10.3390/nu15010165
Ben-Porat T, Weiss-Sadan A, Rottenstreich A, Sherf-Dagan S, Schweiger C, Yosef-Levi IM, et al. Nutritional Management for Chronic Kidney Disease Patients who Undergo Bariatric Surgery: A Narrative Review. Adv Nutr. 2019;10:122-32. doi: 10.1093/advances/nmy112
Majorowicz RR, Attia A, Bamlet HM, Clegg DJ, Diwan T, Erickson AE, et al. Nutritional Considerations for Patients With Renal Failure Undergoing Sleeve Gastrectomy. J Ren Nutr. 2024;34:76-86. doi: 10.1053/j.jrn.2023.08.005
Paccou J, Caiazzo R, Lesspesailles E, Cortet B. Bariatric Surgery and Osteoporosis. Calcif Tissue Int. 2022;110:576-91. doi: 10.1007/s00223-020-00798-w
Pimentel A, Ureña-Torres P, Zillikens MC, Bover J, Cohen-Solal M. Fractures in patients with CKD-diagnosis, treatment, and prevention: a review by members of the European Calcified Tissue Society and the European Renal Association of Nephrology Dialysis and Transplantation. Kidney Int. 2017;92:1343-55. doi: 10.1016/j.kint.2017.07.021
Sumida K, Yamagata K, Kovesdy CP. Constipation in CKD. Kidney Int Rep. 2020;5:121-34. doi: 10.1016/j.ekir.2019.11.002
Dhondup T, Qian Q. Electrolyte and Acid-Base Disorders in Chronic Kidney Disease and End-Stage Kidney Failure. Blood Purif. 2017;43:179-88. doi: 10.1159/000452725
Watanabe R. Hyperkalemia in chronic kidney disease. Rev Assoc Med Bras. 2020;66Suppl 1:s31-s36. doi: 10.1590/1806-9282.66.S1.31
Parrott J, Frank L, Rabena R, Craggs-Dino L, Isom KA, Greiman L. American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient 2016 Update: Micronutrients. Surg Obes Relat Dis. 2017;13:727-41. doi: 10.1016/j.soard.2016.12.018
Ott U, Busch M, Steiner T, Wolf G. Anaemia after renal transplantation: an underestimated problem. Transplant Proc. 2008;40:3481-4. doi: 10.1016/j.soard.2016.12.018
Steenackers N, Van der Schueren B, Mertens A, Lannoo M, Grauwet T, Augustijns P, et al. Iron deficiency after bariatric surgery: what is the real problem? Proc Nutr Soc. 2018;77:445-55. doi: 10.1017/S0029665118000149
Zhao R, Matherly LH, Goldman ID. Membrane transporters and folate homeostasis: intestinal absorption and transport into systemic compartments and tissues. Expert Rev Mol Med. 2009;11:e4. doi: 10.1017/S1462399409000969
Steiber AL, Kopple JD. Vitamin status and needs for people with stages 3-5 chronic kidney disease. J Ren Nutr. 2011;21:355-68. doi: 10.1053/j.jrn.2010.12.004
Guéant JL, Guéant-Rodriguez RM, Alpers DH. Vitamin B12 absorption and malabsorption. Vitamin Horm. 2022;119:241-74. doi: 10.1016/bs.vh.2022.01.016
Harhay MN, Chen X, Chu NM, Norman SP, Segev DL, McAdams-DeMarco M. Pre-kidney transplant unintentional weight loss leads to worse post-kidney transplant outcomes. Nephrol Dial Transplant. 2021;36:1927-36. doi: 10.1093/ndt/gfab164
Bansal S, Wei G, Boucher RE, Beddhu S. Self-reported Intentional Weight Loss and Risk of Death in Moderate Chronic Kidney Disease in the United States. J Ren Nutr. 2018;28:422-27. doi: 10.1053/j.jrn.2018.04.001
Heinberg LJ, Bond DS, Carroll I, Crosby R, Fodor A, Fouladi F, et al. Identifying mechanisms that predict weight trajectory after bariatric surgery: rationale and design of the biobehavioral trial. Surg Obes Relat Dis. 2020;16:1816‑26. doi: 10.1016/j.soard.2020.06.020
Athanasiadis DI, Martin A, Kapsampelis P, Monfared S, Stefanidis D. Factors associated with weight regain post-bariatric surgery: a systematic review. Surg Endosc. 2021;35:4069-84. doi: 10.1007/s00464-021-08329-w
Karmali S, Brar B, Shi X, Sharma AM, de Gara C, Birch DW. Weight recidivism post-bariatric surgery: a systematic review. Obes Surg. 2013;23:1922-33. doi: 10.1007/s11695-013-1070-4
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Ana Beatriz Pinto, Andreia Coroas, Odete Pereira, Susana Sampaio, Cristina Teixeira
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
