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Invited Commentary
May 27, 2020

Bariatric Surgeons Should Operate on Patients With Obesity Who Are Receiving Dialysis

Author Affiliations
  • 1Department of Surgery, University of North Carolina, Chapel Hill
  • 2Department of Biomedical Engineering, University of North Carolina, Chapel Hill
  • 3Lineberger Cancer Center, University of North Carolina, Chapel Hill
  • 4Editor, JAMA Surgery
JAMA Surg. 2020;155(7):588-589. doi:10.1001/jamasurg.2020.0862

The direct association of obesity with overall health is incontrovertible, including an association with increased cardiovascular disease and higher mortality rates. The health outcomes of obesity are further exacerbated in patients with end-stage kidney disease (ESKD), and compounding this problem, the one intervention that can dramatically improve life span, kidney transplant, is often not offered to these patients. Lassalle et al1 showed that patients with a body mass index (calculated as weight in kilograms divided by height in meters squared) of 31 or more were less likely to receive a kidney transplant, and inversely, for every 1-point reduction in body mass index, the likelihood of kidney transplant increased 9% to 11%. The reason why surgeons withhold kidney transplant from patients with obesity is because of an increased risk of delayed graft function, allograft loss, and patient mortality.2,3 Yet, there is a distinct survival advantage for patients with ESKD if they undergo kidney transplant, because the transplant potentially extends life by 7 to 11 years, depending on the causative mechanism of kidney failure.4 Therefore, there is a critical need for weight loss interventions for this patient population.

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