Challenges of Treating a 466-Kilogram Man With Acute Kidney Injury

Abstract

Caring for super obese patients (body mass index >50) presents a number of complex and unique clinical challenges, particularly when acute kidney injury is present. We describe our experience treating the heaviest individual with acute kidney injury requiring renal replacement therapy reported to date. A 24 year old black man was admitted to our hospital with fevers, vomiting, progressive weakness, shortness of breath, and hemoptysis. Admission weight was 1024 lbs (466 kg), height was 6 ft 4 in (1.9 m), and body mass index was 125. During hospitalization the patient suffered oligoanuric acute kidney injury and required initiation of continuous and, subsequently, intermittent renal replacement therapy. This clinical scenario, which identifies many of the kidney and non-kidney related challenges surrounding the care of super obese patients with acute kidney injury, may be a harbinger of what awaits the nephrology community in the obesity pandemic era.

Challenges Associated with Managing End-Stage Renal Disease in Extremely Morbid Obese Patients: Case Series and Literature Review

“…We present 3 cases of patients with ESRD with BMI >50 kg/m 2 , with 2 out of the 3 patients having BMI >75 kg/m 2 . Similar challenges were previously noted in AKI patients [11] ; identifying the cause of ESRD in our first patient was hindered by our inability to perform a renal biopsy as well as limitation of available dialysis modality choices that would have allowed earlier hospital discharge to outside dialysis facilities resulting in one patient remaining in the hospital for more than 4 months with no foreseen discharge plans. As extremely morbid obese patients with ESRD introduce a more individual problem, the several aspects of RRT options deserve further elaboration.…”

“…Friedman et al [11] highlighted some of the challenges associated with the management of an extremely morbid obese patient with AKI. These challenges included longer hospital stay, difficult volume status assessments, difficulty in performing some investigations as renal ultrasound, achieving adequate drug dosing as well as challenges associated with transportation of these patients to the hospital [11] .…”

Acute Kidney Injury in the Critically Ill, Morbidly Obese Patient: Diagnostic and Therapeutic Challenges in a Unique Patient Population

“…103,104 In the first case, a 466-kg man with sepsis and cocaine-induced lung injury underwent continuous venovenous hemofiltration (CVVH) for oligoanuric AKI. CVVH was used initially because of specific hospital plumbing issues, limiting the use of dialysis-based modalities in that specific location.…”

“…Despite adequate achievement of fluid and metabolic control, care was withdrawn due to progressive complications of sepsis. 103 The second reported case was that of a 54-year-old MO woman (BMI not reported) who developed AKI in the setting of a spontaneous cerebellar hemorrhage. CVVH was chosen as the modality of choice with the goal of preventing significant fluctuations in the intracranial pressure.…”

“…62 Use of bedside ultrasonographic techniques for temporary vascular access and interventional radiology services can be of great value in establishing prompt vascular access safely. 103 Several aspects of RRT in critically ill MO patients deserve further mention. Dosing continuous therapies based on actual weight can result in the requirement of impractical and massive volume of replacement fluid.…”