orlistat and Kidney-Failure--Chronic

Obesity has adverse consequences in the general population. In patients with chronic kidney disease (CKD), it is associated with increased inflammation, insulin resistance, hypertension and dyslipidaemia, which are important risk factors for CKD progression and death. In adults with CKD stages 1-4, weight loss should be encouraged, it reduces proteinuria and glomerular hyperfiltration, which are frequent in obese patients. Proposals for modifications of lifestyle, physical activity and calorie restriction are the first measures. Pharmacological treatments are generally unsafe in these patients, except orlistat, but that has modest efficacy. Bariatric surgery may be the only option in severe obesity, if all other measures fail. For obese patients on dialysis treatment, who are eligible for kidney transplantation, weight loss is mandatory to prevent obesity-related surgical complications and improve patient and graft survival after transplantation. Interventions should place an emphasis on exercise to increase muscle mass, and calorie but not protein restriction. Bariatric surgery should be carried out by experienced surgeons due to the high risk of complications. For obese patients who are not considered transplant candidates the benefits of weight loss remain uncertain.

Topics: Anti-Obesity Agents; Bariatric Surgery; Combined Modality Therapy; Diet, Reducing; Exercise; Glomerular Filtration Rate; Humans; Kidney Failure, Chronic; Kidney Transplantation; Lactones; Obesity; Orlistat; Postoperative Complications; Renal Dialysis; Risk Factors; Weight Loss

Topics: Age Factors; Androgens; Dyslipidemias; Humans; Hypertension; Hypolipidemic Agents; Insulin Resistance; Kidney Failure, Chronic; Lactones; Metabolic Syndrome; Orlistat; Progesterone-Binding Globulin; Testosterone; Tumor Necrosis Factor-alpha; Tunica Intima

Obesity increases the comorbidity-adjusted relative risk of developing end-stage renal disease. Body mass index (BMI) > 30 kg/m(2) was a contraindication for transplant in our renal unit until 2008.. Open-label prospective nonrandomized intervention.. All men and women aged 18-75 years with chronic kidney disease (CKD) and BMI > 30 or > 28 kg/m(2) with diabetes, hypertension, or dyslipidemia and otherwise suitable for kidney transplant if on dialysis therapy were eligible to enroll in the weight-management program. 64 patients were referred; 44 agreed to participate in the intervention group and 20 did not wish to take part and constitute the usual-care group.. 24-month weight-management program that included a low-fat renal-specific diet, exercise, and orlistat, 120 mg, 3 times daily.. Body weight, blood pressure (BP), kidney transplant wait listing.. Body weight, BP, estimated glomerular filtration rate (eGFR; calculated using the 4-variable Modification of Diet in Renal Disease [MDRD] Study equation).. 32 patients (73%) in the weight-management program group completed the follow-up evaluation. Baseline mean BMI was 35.7 +/- 4.5 (SD) kg/m(2) in the weight-management program group and 34.1 +/- 4.2 kg/m(2) in the usual-care group. 12 (38%) patients in the weight-management program and 9 (45%) in usual care had stages 3-4 CKD, with the remainder in stage 5 CKD on dialysis therapy. There were no differences in body weight, BP, or eGFR between groups at baseline. After 24 months, mean body weight was 94.6 +/- 16.1 kg in the weight-management program group versus 101.0 +/- 26.8 kg in the usual-care group (P < 0.001), and eGFR was 43 mL/min in the weight-management program group versus 18 mL/min in the usual-care group (P < 0.001). 9 of 26 (35%) otherwise eligible patients in the weight-management program and 1 of 18 (6%) patients in usual care were accepted for kidney transplant listing, with 3 transplants performed in the weight-management program group and 1 in the usual-care group.. Nonrandomized trial, small number of participants.. The weight-management program group showed significant weight loss and weight-loss maintenance in obese patients with CKD and potentially enables obese patients with CKD to undergo kidney transplant.

Topics: Adolescent; Adult; Aged; Anti-Obesity Agents; Body Mass Index; Diet; Dose-Response Relationship, Drug; Exercise Therapy; Female; Follow-Up Studies; Glomerular Filtration Rate; Humans; Kidney Failure, Chronic; Lactones; Lipase; Male; Middle Aged; Nutritional Status; Obesity; Orlistat; Patient Education as Topic; Prospective Studies; Time Factors; Treatment Outcome; Weight Loss; Young Adult

An overweight 56-year-old type II diabetic on peritoneal dialysis (body mass index 35 kg/m(2)) was taking Orlistat for some months up until live-unrelated renal transplantation. Despite oral cyclosporin A (CyA) for 48 hours pretransplantation, it was very difficult to achieve adequate CyA blood levels for the first week postengraftment despite the use of much larger oral CyA doses. After opening his bowels on day 7, and the use of 3 days intravenous CyA, good CyA blood levels were achieved then maintained with conventional oral doses. The authors believe that this case shows important interactions between CyA and Orlistat.

Topics: Administration, Oral; Anti-Obesity Agents; Cyclosporine; Diabetes Mellitus, Type 2; Drug Interactions; Humans; Immunosuppressive Agents; Injections, Intravenous; Kidney Failure, Chronic; Kidney Transplantation; Lactones; Male; Middle Aged; Obesity; Orlistat

Topics: Adult; Cyclosporine; Enzyme Inhibitors; Female; Humans; Immunosuppressive Agents; Kidney Failure, Chronic; Kidney Transplantation; Lactones; Middle Aged; Orlistat; Time Factors