Bariatric Surgery and Kidney-Related Outcomes

Chang, Alexander R.; Grams, Morgan E.; Navaneethan, Sankar D.

doi:10.1016/j.ekir.2017.01.010

Cited by 117 publications

(86 citation statements)

References 74 publications

(94 reference statements)

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“…Clinically desirable reduction of certain biochemical markers, such as creatinine, CRP, uric acid, ALT, AST, GGT, connected with renal and hepato-biliary function or inflammatory activity, was also observed in our study group, but values of these parameters remained in the normal ranges in the whole observation period. Other authors provide information that the overall long-term (above > 12 months) influence of bariatric treatment on kidney, liver and inflammatory function is positive, so these results could be considered as a good prognostic factor also in our assessment [39][40][41][42]. C-reactive protein and other inflammatory marker levels' postoperative increase is also proven to be diagnostic in operation technique related complications, such as bleeding or anastomosis leak [43], but the patients who developed such complications were excluded from the follow-up, and therefore mentioned conclusions on the postoperative inflammatory function could be stated.…”

Section: Niddm Arterial Hypertension Partial Remission (%)mentioning

confidence: 88%

Laparoscopic sleeve gastrectomy: a study of efficiency in treatment of metabolic syndrome components, comorbidities and influence on certain biochemical markers.

Wójciak¹,

Pawluszewicz²,

Diemieszczyk³

et al. 2019

Videosurgery and Other Miniinvasive Techniques

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A b s t r a c tIntroduction: The worldwide outbreak of morbid obesity forced contemporary medicine to adopt a multidisciplinary approach, which led to the description of metabolic syndrome (MS): a disease with self-aggravating components and one of the most important causes of morbidity and mortality. The need for therapeutic methods provoked development of metabolic surgery, which nowadays give possibilities for safe and effective treatment of all MS aspects simultaneously and improves many obesity-related comorbidities. Aim: To assess the laparoscopic sleeve gastrectomy (LSG) procedure's efficiency in resolving MS components, treating comorbidities and to analyze the influence on certain biochemical markers in 1-year follow-up. Material and methods: The retrospective cohort study of 211 patients after an LSG operation relied on statistical analysis of clinical data collected prospectively in follow-up visits. All applicable guidelines and bioethical recommendations were respected in this study. Results: Assessment of bariatric efficiency proved the LSG operation to be effective in inducing significant weight loss and treating obesity. Analysis on the influence on MS components, such as non-insulin dependent diabetes (NIDDM), arterial hypertension (AH) and dyslipidemia, showed substantial improvement in all observed cases of these diseases. In the present study, follow-up also proved a partial remission inducing effect of this bariatric operation in many comorbidities, especially in chronic obstructive pulmonary disease, obstructive sleep apnea, peptic ulcer disease and depression. A desirable reduction in creatinine, C-reactive protein, uric acid, alanine aminotransferase, asparagine aminotransferase, g-glutamyltransferase serum levels has also been observed during the follow-up. Conclusions: The LSG is an effective method of treatment in all areas of metabolic syndrome, provides a significant positive clinical outcome in obesity-related comorbidities and induces desirable changes in inflammatory, kidney and liver related biomarkers.

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Section: Niddm Arterial Hypertension Partial Remission (%)mentioning

confidence: 88%

Laparoscopic sleeve gastrectomy: a study of efficiency in treatment of metabolic syndrome components, comorbidities and influence on certain biochemical markers.

Wójciak¹,

Pawluszewicz²,

Diemieszczyk³

et al. 2019

Videosurgery and Other Miniinvasive Techniques

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show abstract

“…Weight‐reduction therapy improves blood pressure, insulin resistance, dyslipidaemia, and obstructive sleep apnoea . A previous study's findings showed that compared with usual care, obese patients with type 2 diabetes benefitted more from bariatric surgery (BS), which included a lower incidence of nephropathy; however, the study was limited to patients with type 2 diabetes.…”

Section: Introductionmentioning

confidence: 99%

“…4 Potential factors underlying the increased risks for CKD and ESRD include obesity-mediated hypertension, insulin resistance, obesity-related glomerulonephropathy, renin-angiotensinaldosterone system activation, inflammation, and dysregulated adipocytokine production. 5,6 Weight-reduction therapy improves blood pressure, 7 insulin resistance, dyslipidaemia, and obstructive sleep apnoea. 8 A previous study's findings showed that compared with usual care, obese patients with type 2 diabetes benefitted more from bariatric surgery (BS), which included a lower incidence of nephropathy 9 ; however, the study was limited to patients with type 2 diabetes.…”

Section: Introductionmentioning

confidence: 99%

Effect of weight loss on the estimated glomerular filtration rates of obese patients at risk of chronic kidney disease: the RIGOR‐TMU study

Lin

Lai

Lin

et al. 2019

J cachexia sarcopenia muscle

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Background Weight‐reduction therapies, including bariatric surgery (BS), are standard treatments for severely obese patients with type 2 diabetes; however, the outcomes of these therapies are inconclusive for obese patients with chronic kidney disease (CKD). This study aimed to investigate the effects of BS or non‐surgical interventions on the estimated glomerular filtration rate (eGFR) and to determine whether BS can be recommended for renal function preservation based on body mass index (BMI) and eGFR changes in obese patients with CKD. Methods This study used data from the weight Reduction Intervention on GFR in Obese Patients with Renal Impairment‐Taipei Medical University (TMU) study, which was a large, long‐term, propensity score‐matched cohort study based on clinical data from patients who registered at weight‐reduction centres at TMU and its affiliated hospitals from 2008 to 2016. The patients were stratified according to whether they had undergone BS and into the mild, moderate, and high CKD risk groups using the Kidney Disease: Improving Global Outcomes guidelines. The primary outcome was the eGFR calculated using the Taiwan Chronic Kidney Disease‐Epidemiology Collaboration equation. Cox regression models were used to determine hazard ratios (HRs) for eGFR decreases ≥25%. Results A total of 4332 obese patients were enrolled in this study. After propensity score matching, 1620 patients, including 60.2% women, with a mean age of 36.5 (9.9) years were divided into BS or non‐surgery groups ( n = 810 per group). The overall mean eGFRs increased by 4.4 (14) mL/min·1.73 m 2 and decreased by 6.4 (16.0) mL/min·1.73 m 2 in the BS and non‐surgery groups, respectively. The decrease in BMI in the BS and non‐surgery groups were 2.5 and 1.3 kg/m 2 , respectively. In the moderate/high CKD risk BS group, a significant correlation was evident between an increased eGFR and a reduced BMI (Spearman's correlation −0.229, P < 0.001). The Cox regression analysis showed that the BS group had a significantly lower risk of an eGFR decline ≥25% at 12 months [adjusted HR (aHR) 0.47, P = 0.03). After BS, obese patients with hypertension or albuminuria had significantly lower risks of eGFR declines ≥25% (aHR 0.37, P = 0.02 and aHR 0.13, P = 0.0018, respectively). Conclusions Bariatric surgery was associated with eGFR preservation in all obese patients and, particularly, in those with moderate‐to‐high CKD risks. A longer term outcome study is warranted to determine the benefits of BS for CKD patients.

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“…The mean serum levels of C cystatin was signi icantly greater in the postoperative group as compared to preopera-investigated and, in some studies, improvement of the glomerular iltration rate (GFR), reduction of hyper iltration and reduction of microalbuminuria can be observed, preventing the onset of CKD and its progression [15][16][17][18][19][20][21][22][23][24][25][26][27][28]. However, there is no agreement on this issue [29].…”

Section: Resultsmentioning

confidence: 99%

“…In this study, no statistically signi icant difference was observed in relation to the glomerular iltration rate when compared to the pre and post-bariatric surgery groups, corroborating other studies that do not evidence the effect of bariatric surgery on the improvement of renal function. On the other hand, some even suggest a worsening of the renal function after the surgical approach [28,29,40,41]. Thus, adding cystatin C for increasing sensitivity and speci icity for better use of renal function equations did not give evidence for supporting improvement of renal function after bariatric surgery in obese patients.…”

Section: Discussionmentioning

confidence: 98%

Is there improvement in renal function in patients undergoing bariatric surgery?

Bezerra¹,

Ct²,

Borborema³

et al. 2019

J Clini Nephrol

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How to cite this article: Bezerra JAB, Brandt CT, Borborema DMB, Ramos AQ, de Souza MR, et al. Is there improvement in renal function in patients undergoing bariatric surgery? J Clini Nephrol. AbstractIntroduction: Obesity may cause progressive chronic kidney disease. Weight loss in the postoperative follow-up of bariatric surgery may improve renal function in these patients. Thus, the purpose of this study was to give insight on the subject using a sensible biomarker. Methods:This cross sectional study was performed in the Obesity Department from Campina Grande -Paraiba, Brazil. It was randomly enrolled 23 postoperative patients (7 bypass and 16 sleeve), with at least two years of follow-up, from the outpatient Department and 29 (18 bypass and 11 sleeve) in the preoperative period for bariatric surgery. They were homogeneously from both genders with ages ranging from 25 to 57 years. Serum levels of creatinine and cystatin C were measured, and the glomerular fi ltration rate (GFR) was estimated using the CKD Epi (chronic kidney disease epidemiology collaboration) cystatin-creatinine equation. The investigation was approved by the Ethics Committee. Results:The mean body mass index (BMI) of the preoperative group was signifi cantly greater than the postoperative group (p ≤ 0.0001). The mean serum levels of C cystatin was signifi cantly greater in the postoperative group as compared to preoperative (p= 0.0197). However, there was no mean difference between creatinine serum concentrations comparing the two groups (p = 0.3252). The mean glomerular renal function rates of the groups were similar (p = 0.1240). Conclusion:There is no defi nitive evidence for supporting the hypothesis that there is improvement in the kidney renal function after bariatric surgery in obese patients. Prospective cohorts are necessary to enlighten the answer for this important question.

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Bariatric Surgery and Kidney-Related Outcomes

Cited by 117 publications

References 74 publications

Laparoscopic sleeve gastrectomy: a study of efficiency in treatment of metabolic syndrome components, comorbidities and influence on certain biochemical markers.

Laparoscopic sleeve gastrectomy: a study of efficiency in treatment of metabolic syndrome components, comorbidities and influence on certain biochemical markers.

Effect of weight loss on the estimated glomerular filtration rates of obese patients at risk of chronic kidney disease: the RIGOR‐TMU study

Is there improvement in renal function in patients undergoing bariatric surgery?

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