Background <p>Bariatric surgery has gained significant attention as a potential approach for improving access to kidney transplantation (KT) in dialysis-dependent patients with severe obesity. However, there is lack of literature on how to manage peritoneal dialysis (PD) in patients with severe obesity undergoing bariatric surgery. This study aims to describe the protocol used in this specific patient population at a single academic center, focusing on the important role of the multidisciplinary team in managing this vulnerable group of patients.</p> Methods <p>This retrospective review included PD-dependent patients who had bariatric surgery at a single academic center between January 2017 and December 2024. Baseline demographics, body mass index (BMI), perioperative dialysis transitions, and postoperative outcomes were recorded.</p> Results <p>A total of 66 dialysis-dependent (stage 5D) patients underwent bariatric surgery during the study period, of which 11 patients (17%) were on PD preoperatively. Median age of the PD patients was 51 years, and 82% were males. The median baseline BMI for the PD patients was 41&#xa0;kg/m², and all of them underwent laparoscopic sleeve gastrectomy (SG). Most PD patients (70%) were transitioned to hemodialysis (HD) within 1 week before SG, otherwise they received the HD access. After surgery, patients remained on HD with a median interval of 6 weeks prior to resuming PD. All patients received HD before and after surgery at their own home institutions but were added to dialysis unit at the bariatric center during hospital admission after surgery. There were no reported 30-days postoperative readmissions or major complications.</p> Conclusion <p>Our preliminary results show that PD-dependent patients with severe obesity can safely undergo SG as a bridge to or while awaiting KT, with no major early complications. Most patients resume PD within six weeks after surgery.</p>