Weight Management Tips for Patients on Hemodialysis
Article Outline
The prevalence of overweight and obesity in the renal population is increasing at an exponential rate proportionate to the prevalence seen in the general U.S. population. Dialysis units and transplant centers alike are faced with an estimated majority of patients (60%) awaiting transplantation who considered overweight or obese.1 Obesity as reflected by a body mass index (BMI) of 30
kg/m2 or over is associated with increased morbidity from hypertension, dyslipidemia, type 2 diabetes, congestive heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea and respiratory problems, and certain types of cancer. Obesity is attributable to premature death and an increase in all-cause mortality.2
Patients with chronic kidney disease may find that their BMI alone can prevent them from being a suitable candidate for kidney transplantation. Several studies indicate that obesity at time of kidney transplantation has an adverse affect on graft function and patient survival.3 Evidence suggests that patients with elevated BMI may have a higher incidence of perioperative complications including delayed graft function, delayed wound healing, ventral hernias, deep vein thrombosis, and increased risk of various infections.4 Beyond the acute post-transplant period, the obese patient on chronic immunosuppressant therapy accumulates additional risk factors for adverse long-term renal outcomes such as new-onset diabetes after transplantation (NODAT), uncontrolled hypertension, hypercholesterolemia, hypertriglyceridemia, cardiac event, and significant unintentional weight gain versus the normal-weight patient.5, 6 Given the clinical implications of pretransplant obesity, every effort should be made to address this issue to optimize transplant outcomes. Transplant centers have defined BMI requirements that must be met prior to candidacy for renal or renal-pancreas transplant. Because each transplant center may use different criteria for eligibility, patients and members of the dialysis team should be aware of the BMI criteria for the referred transplant center. Patients who are not eligible for transplantation because of obesity should receive individualized therapy emphasizing a healthy lifestyle and weight loss.
Successful weight management requires a multidisciplinary approach. The health care team members may consist of the following: renal dietitian, social worker, nurse, exercise physiologist, and physician. The dietitian works diligently with the patient on goal setting, food label reading, modifying food and beverage portions, emphasizing healthier food choices, and individualizing the diet to promote body fat reduction while maintaining or optimizing adequate nutrition status and other laboratory studies. In addition, for the patient in need of oral nutritional supplements, the dietitian is the resource for providing appropriate nutritional supplements that will meet the needs of the patient while accommodating for weight loss efforts. The social worker assists the patient in identifying high-risk situations and behavior patterns, counseling the patient to resolve potential mental health issues (i.e., depression), and developing relapse-prevention techniques. The exercise physiologist assesses the patient for physical aptitude and provides an exercise prescription for regular physical activity. The nurse provides encouragement and carefully monitors for changes in estimated dry weight. The physician involves the patient's family in discussing the benefits for attaining a healthy weight, encourages the patient directly, and is the catalyst for promoting the patient's needs by making timely referrals to the other health care professionals when needed. A social support system that provides ongoing motivation and skill development is the key to successful weight reduction.
This handout is a teaching tool adapted from the UC Davis Health System that is designed specifically for hemodialysis patients to guide them in their weight loss efforts while on the renal therapeutic diet. This educational material provides a template for initiating healthy weight loss that addresses the three main components associated with unintentional weight gain: poor dietary choices, lack of physical activity, and emotional coping patterns. The handout outlines a plan of action that includes 10 basic steps for the patient to follow toward the established weight goal. The information may be presented to patients in its entirety or in part based on the individualized intervention needed.
Supplementary material
Weight No More handout
References
- Demographics and trends in overweight and obesity in patients at time of kidney transplantation. Am J Kidney Dis. 2003;41:480–487
- Office of the Surgeon General: The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity. 9th ed.. Rockville, MD: US Department of Health and Human Services PHS/Washington, DC: US Government Printing Office; 2001;
- . The impact of body mass index on renal transplant outcomes: a significant independent risk factor for graft failure and patient death. Transplantation. 2002;73:70–74
- . Obesity and kidney transplantation. Am J Kidney Dis. 2004;43:943–952
- Effect of overweight on kidney transplantation outcome. Transplant Proc. 2007;39:2202–2204
- . Issues of obesity in kidney transplantation. J Ren Nutr. 2007;17:107–113
PII: S1051-2276(09)00279-9
doi:10.1053/j.jrn.2009.10.001
© 2010 National Kidney Foundation, Inc. Published by Elsevier Inc All rights reserved.
