Created with the collaboration of Dr. Georgina B. Piccoli, Martina Ferraresi, Irene Moro, Gerardo Di Giorgio, Federica N Vigotti:

SS Nephrology and Dialysis, San Luigi Gonzaga Hospital, Orbassano (TO)

INTRODUCTION

The starting assumption was that obesity is a major risk factor in hemodialysis, adversely affecting the outcome of kidney transplantation, and that obese patients are not allowed to waiting lists for kidney transplant. Weight loss is a critical point for dialysis, due to the important metabolic impact of a hypercatabolic state.

Dialysis patients are people with very delicate metabolic conditions, in which the main mechanisms of homeostasis are altered and, in some cases, exhausted. These are people that easily undergo metabolic changes as a result of any lifestyle change in their eating habits.

It is especially because of such sensitive condition that dialysis patients are monitored closely from the point of view of blood tests performed during the dialysis sessions. Constant blood level monitoring is important in order to make the necessary corrections, to avoid or prevent the onset of any health problems associated with any metabolic dysregulation.

Therefore, implementing this new diet, freely chosen by the patient himself/herself, demonstrates very low potential risks thanks to the continuous supervision and monitoring operated by highly qualified medical personnel.

The objectives were:

• Verifying that the Bioimis Nutritional Program was effective on reducing body weight in these patients;
• Verifying that weight loss obtained by following this method would not involve significant or risky metabolic changes in terms of health.

METHODS

The three patients freely chose to participate in the Bioimis Nutritional Program, and were launched to the new diet in the same manner as all other participants.

The Bioimis Staff, as procedure, recorded changes of the interested measures and provided them with the menu for the following days.

Hemodialysis was adjusted to at least 15 ml / min from the equivalent renal function, and applied in variable sessions per patient from 2 to 6. During each session, all parameters, normally detected in dialysis sessions, were detected.

The observation period for each member was related to the "Ideal Fit" program, ranging from two to six months depending on the pounds to lose.

RESULTS

Patient 1: man aged 49, 18 kg overall weight loss, going from a  31.7 to 25.5 BMI. The values of creatinine, sodium, hemoglobin, calcium, phosphate remained constant, PTH gradually decreased. Blood test data pre-and-post-dialysis: hemoglobin 11.7-10.8 g / dL, sodium 136-137 mmol / L, potassium 4.6-5.8 mmol / L, calcium 2.62-2.51 mmol / L, phosphate 5.9-4.1 mg / dl, parathyroid 869-72 pg / ml. In this case the decrease of weight allowed the patient on the list for kidney transplant.

Patient 2: 42-year-old man,  14 kg overall weight loss, going from 39.9 to 34.7 BMI in three months. Hemoglobin, sodium, calcium, phosphate constant throughout the observation period. Blood test data pre- and post-dialysis: hemoglobin 11.7-12.4 g / dL, sodium 138 mmol / L, potassium 4.9-5.4 mmol / L, calcium 2.55-2.53 mmol / L phosphate 7-5.1 mg / dl, parathyroid 887-537 pg / ml.

Patient 3: 56-year-old male, 18 kg lost, with BMI increased from 37.5 to 31.4 in 6 months. Stable blood test parameters, with the exception of parathormone that, at the end of the program, was lower than a third of the starting values. Pre- and post-dialysis blood test data: hemoglobin 12.1 g / dL, sodium 140-138 mmol / L, potassium 4.9-5.4 mmol / L, calcium 2.34-2.16 mmol / L phosphate: 4.6-4.1 mg / dl, parathyroid 1718 -455 pg / ml.

CONCLUSION

In conclusion, all three patients lost weight without significant impact on the monitored blood test parameters. In addition, in these three subjects, dialysis did not need to be particularly changed. The Bioimis Nutritional Program has proved to be not only effective, but also safe for the health of its participants, despite the patients’ sensitive metabolic condition due to the disease. An unexpected result was the PTH reduction in all three cases, a certainly positive information, but that deserves further investigation and analysis.

As a result of this collaboration, given the promising results and weight loss benefits obtained on the three patients, a new study protocol was prepared, on a larger scale, which has already received the reference hospital’s ethics committee's approval and is, at this time, in the process of recruitment.