Weight loss surgery using the intragastric balloon (IGB) method in obese patients with chronic kidney disease (CKD) can lead to a high rate of complications with only a moderate change in weight loss, according to new research.
The study, “Does Intragastric Balloon Treatment for Obesity in Chronic Kidney Disease Heighten Acute Kidney Injury Risk?” was published in the journal Nephrology
Obesity not only triggers kidney disease, it also contributes to its progression. Surgical treatment of obesity can be effective in inducing weight loss in CKD patients. But patients with kidney disease are at high risk of developing problems following weight loss surgery.
When compared to patients without CKD, patients with stages 3–4 CKD, or moderate to advanced kidney impairment, are 1.5 times more likely to suffer complications after weight loss surgery than patients without kidney disease.
Nutrient malabsorption, dehydration, kidney stones, and acute kidney injury (AKI) are some of the reported complications reported in CKD patients who underwent common surgical procedures for weight loss.
Here, researchers intended to determine the effectiveness and safety of the weight loss surgical procedure IGB in obese patients with CKD over a period of six months. The authors also wanted to identify any IGB-related complications and adverse events and also examine the patients’ acceptability of the procedure.
An IGB surgical approach requires the insertion into the stomach of a fluid-filled silicone device inflated to a fixed volume. This procedure promotes a restricted food intake while keeping the normal stomach absorption function.
Nine obese patients with stages 3–4 CKD were enrolled in the study. The patients underwent IGB insertion, after which acute changes in kidney function, including AKI episodes, were evaluated. Six months later, the IGB device was deflated and removed. During this period, the patients’ weight loss was assessed.
All patients showed weight loss after IGB treatment, with a mean body mass decrease of 9.6%. Although moderate, this IGB-induced weight loss was greater than that observed after dietary and physical activity changes, with drug-based therapy in obese patients with CKD.
The study also demonstrated that IGB treatment could contribute to reduced cardiovascular risk in obese patients with CKD by inducing a decrease in total cholesterol levels and overall abdominal fat.
However, the authors reported the occurrence of gastric lesions before IGB insertion and five episodes of AKI in three patients after IGB insertion. At IGB removal, inflammation of the stomach and esophagus in one patient was reported.
“Treatment with IGB has only moderate efficacy on weight loss, yet it results in a high rate of complications in obese patients with established CKD. The risk of AKI may be raised due to increased risk of dehydration secondary to gastrointestinal symptoms associated with IGB placement and reduced baseline kidney function,” the authors wrote.