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

Obesity has grown into an epidemic across the globe. Mirroring this growth in the number of obese individuals in the general population, the prevalence of obesity and extremely morbid obesity (body mass index >50 kg/m2) is similarly rising in patients with end-stage renal disease (ESRD). Obesity, and more so, extremely morbid obesity, creates additional challenges for clinicians aiming at providing the best treatment options to patients with ESRD. Although literature is available regarding renal replacement therapy (RRT) for obese patients, literature about challenges facing clinicians managing ESRD in the extremely obese patients is lacking. Furthermore, the optimal strategies and goals for managing these patients with ESRD are not well defined. To our knowledge, no study has been done evaluating RRT options available to extremely morbid obese patients and the challenges associated with these options. Here, we report a case series and discuss the potential challenges faced by extremely obese patients with ESRD requiring RRT.