The obesity in kidney transplantation candidates – methods of treatment

The epidemic of morbid obesity is becoming more likely in patients with chronic kidney disease, worsening the control of comorbid conditions and total cardiovascular risk. Furthermore, it delays or makes the kidney transplantation impossible and sometimes even bypasses obese candidate when the organ becomes available. Most surgical centers consider transplantation if BMI does not exceed 35 kg/m2. The patients with BMI > 35 kg/m2 are at great risk of perioperative and postoperative complications and are usually disqualified. Although overweight and obese, dialysed patients have lower general mortality compared to normal weight (reverse epidemiology paradox), kidney transplantation is still a treatment of choice for them. The conservative methods of weight loss fail in many cases. Pharmacological treatment is contraindicated in CKD. The alternative for these patients is bariatric surgery – with acceptable risk of complications and higher rates of successful and permanent weight loss. After the bariatric procedure the malabsorption of immunosupresive drugs occurs and the doses regimen should be individual and well controlled.