Proposed Topic (Most preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Proposed Topic (Second preferred): :
HA Young Investigators Session (Projects to be presented by HA staff who had joined HA for 10 years or less)
Authors (including presenting author) :
FAN TY, HO CH, YU MWV
Affiliation :
Department of Dietetics, Queen Mary Hospital
Introduction :
Calcium and vitamin D insufficiencies are well-documented among morbidly obese patients after bariatric surgery which carries a known side effect of malabsorption. Post-operative supplementation is crucial to mitigate the risks of deficiencies and bone mineral disorders (BMD). Supplementation becomes challenging when both nutrient requirements are altered in patients with end stage renal disease (ESRD) which poses higher risk of BMD after the surgery.
Objectives :
We presented a case of a patient with ESRD receiving renal replacement therapy (RRT) undergoing bariatric surgery. Bone mass, daily calcium and vitamin D intake before and 6 months after the surgery were monitored. Post-operative calcium and vitamin D intake were compared against the nutrient recommendation for patients with ESRD after bariatric surgery.
Methodology :
A 54-year-old Chinese female with a BMI 46.7 kgm-2 suffered from type 2 diabetes mellitus, hypertension, congestive heart failure, fatty liver, obstructive sleep apnoea and ESRD. She received regular haemodialysis and was required to lose weight for eligibility of renal transplantation. Laparoscopic sleeve gastrectomy (LSG) was performed uneventfully, and haemodialysis was resumed afterwards. She was prescribed with a multi-micronutrient supplement, Daily 1 Plus 1 tab daily, vitamin B12 1000 mcg every 3 months, Calcitriol 0.25 mcg for 2 days per week and ferrous sulphate 300 mg twice daily. She was regularly reviewed by experienced dietitians in a multidisciplinary outpatient clinic post-operatively to ensure dietary compliance. During every visit, bone mass was estimated via bioelectric impedance analyser (MC-980, Tanita) and 3-day diet record was collected for nutrient analysis via a nutrient analysis program (Food Processor, ESHA).
Result & Outcome :
Patient’s bone mass changed from 2.1 kg before LSG to 2.2 kg at 6 months after LSG. The average daily calcium intake decreased from 716.5 mg/day to 571.5 mg/day, fulfilling the recommended intake of less than 800 mg daily to avoid hypercalcaemia. Vitamin D intake increased from 67 IU/day to 427.7 IU/day, less than the daily recommendation of 3000 IU in form of cholecalciferol.
This case has an encouraging outcome of slight increase in bone mass, though vitamin D supplementation can be enhanced to aid calcium absorption to reduce BMD risk. This case highlighted the importance of individualised micronutrient supplementation to balance between nutrition adequacy and toxicities for patients with ESRD undergoing RRT after bariatric surgery.
