With the US obesity rate being over 42%, up to 33% have some form of kidney disease. Those are somewhat alarming statistics along with other conditions that affect obese adults and children. According to an article in the National Library of Medicine, obesity is a huge problem for patients with ESKD on dialysis.1 As we have discussed before, the requirements for kidney transplant can be somewhat stringent. The weight requirement is one at the very top of the list.
The reason why weight before transplant is so important is that they want to make sure that your body is healthy enough for the surgical procedure and for maintaining your transplant. The kidney transplant requirement is based on a potential patient's body mass index. The maximum body mass index to be listed for transplant is 40, which is approximately 190–328 pounds, taking height into consideration.2 Height and weight proportion is also important. Even so, to be on the safe side, you may be required to lose more weight to be listed.
In my personal experience, I have always struggled with my weight. Although I was genetically predisposed to have certain health problems based on heredity, had I consistently adopted healthier lifestyle choices, things may not have turned out the way that they did. During my time on hemodialysis, I had so many issues with my graft failing, to the point that they had to find another dialysis site. The doctors were doing their best to find another hemodialysis access site and they were not ideal areas for me. One site choice was just too invasive. I was then given the option to consider peritoneal dialysis (PD). After much prayer, consideration, and several YouTube videos, I made the decision to do PD.
During the course of PD, my doctor informed me that it would be possible for me to get placed on the transplant list. I checked all the boxes, except for one area—my weight. At that time, my weight was approximately 260 or so pounds. My highest weight in general was 286 pounds. The doctor suggested weight loss surgery. I was not really sold on the whole idea at first, so I asked if I could attempt to lose weight on my own with diet and exercise. Although I did lose some weight, it was not enough to be placed on the transplant list. I had to take a long hard look at the big picture, which was that a transplant would further improve my quality of life. I then started the process for weight loss surgery. I will honestly say the only thing that I wish that I had done is gone through the mental health evaluation. It was not one of the necessary requirements for my insurance, but I believe that it may have helped in the long run. After meeting all of the requirements, I was off to surgery, which was vertical sleeve gastrectomy or gastric sleeve. The surgery went well, and I was sent home a day or so after. My prescription for dialysis was changed to give time to heal after my surgery. In the meantime, one of the main things that is necessary since you cannot eat after the weight loss surgery is to stay as hydrated as possible. That should be attainable for the average person; however, with me being on PD, whatever fluid went in, came out with dialysis treatment. I became severely dehydrated and had to go back to the hospital. After I healed up, everything was getting better, and I was eventually placed on the transplant list. After my sleeve surgery, my weight went down, I was off of all of my BP medications and had almost no insulin. BP and blood glucose were normal. Things were going well. After my transplant, I woke up on three BP medications, two insulins in multiple doses, and a variety of other medications. I was in shock and tears because I was not mentally or emotionally prepared for all of the changes I would have to make. Having to take steroids and the amount really took over. The steroids severely increased both my blood sugar and my appetite. To be honest, in my opinion, I do not even look like I had weight loss surgery. However, I am now making great strides to get back to the level of healthiness that I desire to be. With or without transplant, we all have to do what is necessary to preserve our quality of life. I am doing my best to consistently make healthy lifestyle changes so that I and my kidney can be around for the long haul.
Acknowledgments
The content of this article reflects the personal experience and views of the author(s) and should not be considered medical advice or recommendation. The content does not reflect the views or opinions of the American Society of Nephrology (ASN) or Kidney360. Responsibility for the information and views expressed therein lies entirely with the author(s).
Disclosures
The author has nothing to disclose.
Funding
None.
Author Contributions
Data curation: LaMorgan Smith.
Writing – original draft: LaMorgan Smith.
Writing – review & editing: LaMorgan Smith.
References
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