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Kidney Week

Abstract: SA-PO044

Multilevel Challenges Faced in Renal Replacement Therapy of Morbid Obesity

Session Information

Category: Diversity and Equity in Kidney Health

  • 900 Diversity and Equity in Kidney Health

Authors

  • Frauenfeld, Lina, University of Florida College of Medicine, Gainesville, Florida, United States
  • Pramod, Sheena, University of Florida College of Medicine, Gainesville, Florida, United States
Introduction

We discuss the challenges faced in treatment options in a morbidly obese patient with advanced CKD
Methods: Dialysis modalities have significantly improved over the years with several options. Home dialysis increases patient autonomy, portability and compliance, but remains low due to multiple challenges.

Case Description

57 year old male is referred to with advanced CKD. PMHx includes morbid obesity, gastric bypass in 2003, anemia and proteinuria. Previously, patient weighed 700 lbs, before gastric bypass, and went down to 300 lbs. He is 598 lbs at the time of evaluation. Since 2018, he has been bedridden due to back issues and has not been able to leave his home until his visit in a modified stretcher. Labs reveal: Serum Creatinine of 4.1 mg/dl, EGFR (CKD-EPI) of 16 mL/min/1.73m2, microalbumin/Creatinine ratio 938 mg/g creatinine and urine protein creatinine ration 2,272 mg/g creatinine suggestive of secondary FSGS. On follow up visit, he reports mild uremic symptoms, resulting in a discussion regarding his RRT options. In-center HD was not an option given his physical condition and inability to sit in HD chair or weight bear. Home HD was considered, but 6 week home training was not feasible because of wife’s work needs, bariatric stretcher unable to fit through doorways, and out of pocket costs of transportation for training. We considered PD as a last option. He would need a pre-sternal PD catheter placed given his large pannus. Surgeon though agreeable to place pre-sternal PD catheter, if cleared by anesthesia, sadly, his bariatric stretcher was too large to fit the local dialysis home units, prohibiting his training and an option to perform PD training at home was limited. The only future alternative is him presenting to emergency room for inpatient hemodialysis knowing that he may not receive OP placement. He was referred for home palliative care simultaneously.

Discussion

This case highlights the challenges faced by our morbidly obese population which are growing in numbers despite the advancements that have been made in home hemodialysis. Dialysis and insurance companies should incentivize and support units to provide training at patient’s homes, alleviating some of the hurdles faced in improving the shift to home therapy. The ability to train younger patients such as ours in their own homes may alter their clinical trajectory.