Mrs Martha Bibiana Parra Guasca1, Ms Meri Manafi1, Dr Alan Parnham2, Dr Rebecca Angus1
1Gold Coast Hospital and Health Service, Nutrition and Food Services, Southport, Australia, 2Gold Coast Hospital and Health Service, Renal Medicine, Southport, Australia
Background
Very low calorie diets (VLCD) have been used safely for weight loss in chronic kidney disease, despite previous concerns about further damage to kidney function through increased protein catabolic load, diuresis, and risk of electrolyte derangements. However, no data is available to guide the use VLCDs in acute kidney injury (AKI). This case study reports on successful VLCD use in the acute setting in a patient with AKI and class III obesity with comorbid complications.
Case report
A 45yo woman (271kg; BMI 86 kg/m2) attended hospital following a fall. Developing complications attributed to obesity and preventing discharge including immobility, deconditioning, fluctuating renal function and AKI, fluid overload, oxygen desaturations and hypoxia. A VLCD was initiated for rapid weight loss despite the manufacturer-stated contraindication for AKI. VLCD adjustments were made to account for the patient’s higher requirements, fluid and salt restrictions. Daily medical and twice weekly dietetic reviews were made to ensure safety of the VLCD program. Electrolyte levels were monitored daily until AKI resolved at VLCD week 5 and thereafter with high regularity as the patient remained on diuretics. No adverse side effects regarding electrolytes, fluid, or kidney function were observed. The VLCD program was continued for 13 weeks of admission, with various adjustments undertaken in consultation with the patient to address weight plateaus and promote adherence. The patient was discharged home after six months of hospitalisation, having attained a 76kg weight loss (BMI 62 kg/m2).
Conclusions
VLCD may be safe for use in patients with AKI during hospitalisation under close medical supervision.
Seizing the opportunity of protracted hospital admission to address obesity can improve overall patient outcomes.
Biography:
Bio to come