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Pubblicato il 9 aprile La sfida del dimagrimento nell'obeso in trattamento dialitico. Case report Obese, on dialysis: Doctor, how may I have access to tranplantation? La durata delle sedute dialitiche è stata modulata al fine di accompagnare adeguatamente la perdita di peso, ed il sodio nel dialisato è stato incrementato per consentire una rigorosa dieta iposodica.

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Abstract Obesity is increasingly encountered in dialysis patients, who have difficulty to lose weight. Thus, losing weight becomes a must for young obese patients, however the best policy to obtain it if any is not defined. The aim of the present case report is to suggest that tailored dialysis and intensive diets could be a successful combination, that should be tested on c2 per la perdita di peso larger scale.

A year-old obese male patient BMI The diet, alternating 8 weeks of rapid weight loss and maintenance phases, was based on a combinations of different foods, chosen on the account of glycaemic index and biochemical properties.

It was salt free c2 per la perdita di peso olive oil was permitted in liberal quantities.

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Dialysis duration was increased to allow weight loss, and dialysate Na was incremented to permit a strict low sodium diet. Over a period of 21 months, the patient attained a Main metabolic data remained stable pre diet and end of the diet period: albumin 3. Conclusion: Daily dialysis may allow enrolling obese hemodialysis patients in intensive weight loss programs, under strict clinical control.

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Background: an impossible mission? Should we convince him-her trying the th diet? Should we desperately look for a transplant Center agreeing to wait-list our obese patient?

Intensive weight-loss in dialysis: a personalized approach

Should we look for a bariatric surgeon, accepting to treat a dialysis patient, accepting the risks of rapid weight loss on dialysis, and, eventually, not to wait list our patient due to the frequent complications of invasive surgery? In the context of the global obesity epidemic, obesity is increasingly encountered in dialysis patients [1].

This is due to evolving epidemiological features in Western and developing Countries where obesity is a rising concern. A recent systematic review underlined the importance of weight loss in slowing the progression of kidney diseases and underlined also how the best way form attaining weight loss is far from being defined [5].

The problem of obesity and consequently weight loss on dialysis has often been defined as a paradox [6] [7].

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The dialysis population is at constant threat of malnutrition and protein energy malnutrition are strictly associated with mortality risks. Indeed, the survival of dialysis patients may be overall too short to demonstrate the risks linked to obesity and overweight [8] [9] [10].

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Losing weight is required by several transplant Centers, in perdi peso su t3 to better manage the limited resources available.

Indeed, it has been reported a survival advantage for obese transplanted patients compared to obese patients on dialysis. However, the best way to lose weight is far from being defined, and the most effective treatment for morbid obesity on dialysis, i.

Furthermore, it is not clear how to treat obese patients that require dialysis. In fact, obesity is often considered a relative contraindication to peritoneal dialysis as it impairs dialysis efficiency, and may pose challenges in obtaining vascular access.

Epatite virale: l'esperto risponde

Despite, at least theoretically, non-conventional dialysis schedules - such as daily or nightly dialysis - may have specific advantages, as far as we are aware no study combined the two issues of daily dialysis and weight loss in End Stage Renal Disease ESRD patients. In dialysis patients, hypercatabolic states, leading to hyperphosphatemia or hyperkalemia, are common threats that could increase during rapid weight loss. Thus, testing the combination of intensive dialysis and intensive weight loss will open new perspectives for our patients.

Aim of the present case report is to describe a patient who attained a remarkable weight loss Therefore, this case may suggest a tailored and intensive dialysis approach to young and motivated obese dialysis patients, which primary therapeutic goal should be transplantation.

The case In this report we describe a 56 year old male patient on dialysis since February The patient was overweight since the adolescence, except for a period between 20 and 35 years of age, when he lost weight by physical exercise and a careful self-made diet, reaching the weight nadir 75 Kg, BMI Therefore, he gradually and progressively regained weight up to a maximum of In the patient underwent a kidney biopsy confirming a diagnosis of acute glomerulonephritis.

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Two years later, he was treated with ACE-inhibitor and angiotensin-receptor-blockers because of persistent nephrotic proteinuria. However, in spite of all efforts, his renal function gradually worsened.

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Nowadays, no available data allow defining the disease as strictly obesity related. The patient was referred to our Unit inwith creatinine 3. He started a vegan supplemented low protein diet, which he followed for about one year with good compliance, until the start of dialysis.