Bariatric Nephrology

This morning, I am presenting at the Nephrology Educator's Forum in Lake Louise. The audience are nephrologists from across Canada.

The fact that I was invited to speak on obesity is of course related to the fact that nephrology, as practically all fields of medicine, are beginning to see the impact of the obesity epidemic.

Indeed, from a nephrologist's perspective (remember - I am one), not only is obesity a major driver of the most common causes of end-stage renal failure (i.e. type 2 diabetes and hypertension), it also complicates things for patients on dialysis (especially peritoneal dialysis) and renal transplantation.

While there is an apparent survival paradox, whereby obese patients with end-stage renal failure seem to do better than leaner patients (a similar paradox is seen for other chronic diseases including heart failure and chronic obstructive lung disease), there is a high likelihood that this paradox is largely explained by malnutrition or more severe comorbidities than by a true protective effect of the extra weight. Perhaps, maintaining a higher weight or even gaining more weight is simply a sign of adequate nutrition and therefore a surrogate marker for "better health" and thus better outcomes.

On the other hand, in dialysis patients awaiting transplantation or patients who have had transplants, severe obesity and/or further weight gain can be a major problem. Not surprisingly, there is now an increasing number of reports on patients with end-stage renal failure undergoing bariatric surgery either prior to or following kidney transplantation - apparently with great success.

Clearly, the brunt of the obesity epidemic on nephrology is still ahead - nephrologists, like everyone else, will probably have to brush up on the essentials of bariatric care.

AMS

Caps off to CABPS

It is now widely agreed that looking after obese patients is far more sophisticated than simply advising patients to "eat less and move more".

In fact, the field of bariatrics is rapidly growing into an entity of its own, not just with regard to bariatric surgery but also with regard to bariatric medicine, bariatric nursing, bariatric psychology, bariatric nutrition and other relevant aspects of bariatric care.

It is therefore with great pleasure that I announce the launch of the Canadian Association of Bariatric Physicians and Surgeon's (CABPS) new website at www.cabps.ca

The mandate of CABPS is:

- To bring together Canadian Physicians and Surgeons with a special interest in Bariatric Medicine and Surgery in order to maintain and improve the standards of Bariatric care in Canada.

- To support both primary and continuing educational programs in Bariatric Medicine and Surgery.

- To advance knowledge in the field of Bariatric Medicine and Surgery.

- To facilitate and promote research in the field of Bariatric Medicine and Surgery.

- To develop policies and new ideas in the areas of clinical care, education, and research in Bariatric Medicine and Surgery.

- To represent the views of the Bariatric Physicians and Surgeons of Canada.

- To facilitate communication between the public, the medical community and the ministries of health at the provincial and federal level so as to promote awareness of the health risks of obesity and severe or morbid obesity, the financial and health burden to the individual and to society, and the efficacy of medical and surgical treatment options.

Membership in this organisation is open to all physicians and surgeons with an interest in bariatric care.

Membership (at reduced cost) is also open to all allied health professionals, residents and trainees working in related areas.

Membership forms can be downloaded from the site.

AMS