Renal Nutrition Vital Following Bariatric Surgery

Specific renal nutrition needs must be met to improve post-bariatric surgery outcomes, particularly for patients with chronic kidney disease (CKD), according to a new review.

According to researchers at the University of Washington, the physiologic changes a patient experiences after bariatric surgery require consideration of overall dietary requirements, in addition to specific renal nutrition needs that must be met in order to improve post-surgical outcomes. Patients should begin changing their diet prior to surgery, as a preoperative weight loss of at least a 5% loss in total body weight is associated with fewer post-surgical complications, as well as predicting greater weight loss following the procedure.

Patients who undergo bariatric followed by renal transplant surgery face a particular challenge in staying hydrated, requiring a fluid intake of around 2.5-3 liters of liquid daily for improved kidney outcomes. Frequent lab checks are required for all post-bariatric surgery patients, but particularly for those with CKD or on dialysis in order to monitor vitamin and mineral deficiencies very closely. Calcium, folic acid, and iron are among some of the most common deficiencies, even prior to surgery, mainly due to lack of food intake during the first six months post-surgery.

To mitigate post-surgical deficiencies, complete water-soluble multivitamin tablet supplements, rather than gummies and liquid vitamins are recommended, as most of these lack minerals. The researchers also suggest taking higher quality bariatric-specific formulas, even at a higher cost. Hormonal issues, such as hair loss, can arise if supplement quality is low, and particularly if the patient loses a lot of weight very rapidly. They endorse the American Society of Bariatric and Metabolic Surgery (ASMBS) clinical practice guidelines, which recommend checking values of vitamins A, E, K, serum copper, B12 as methylmalonic acid, folate, and others.

Other post-surgical hormonal issues may include dumping syndrome, an endocrine response within the first fifteen minutes after eating due to food dumping from the pouch to the small intestine, resulting in serious, flu-like side effects, and reactive hypoglycemia, when blood glucose levels become dangerously low following a meal. On the positive side, most patients will not require phosphate binders following bariatric surgery, mainly due to the small portion sizes of meals.

“The ASMBS is expected to release updated, integrated clinical practice guidelines later this year. These new guidelines will recommend patients take about 200% of daily value of vitamins and minerals for at least the first three to six months after surgery, which is about two multivitamins daily,” said Debra Clancy, RD, CD, who presented the oral session at the National Kidney Foundation (NKF) spring clinical meeting, held during April 2017 in Orlando (FL, USA). “Dialysis patients on renal supplements will be guaranteed to have deficiencies in some minerals, and these patients will require additional supplementation.”