CKD.QLD: Effect of bariatric procedures on renal and non-renal parameters in obese CKD patients

Abstract

Background: Obesity has an adverse impact on metabolic parameters including CKD. Bariatric procedures produce significant weight loss compared to non-surgical means and have a positive effect on renal and non-renal parameters. The present study retrospectively evaluated the effect of bariatric procedures and weight loss on renal function, proteinuria, hypertension, lipid profile and diabetic status in chronic kidney disease (CKD) patients in Queensland, Australia. Methods: Of the 880 patients who consented to the CKD Registry, data of patients who underwent bariatric procedures were analysed. Changes in anthropometric measures, renal functions, lipid profile, glycosylated haemoglobin A 1c (HbA 1c ) (%), proteinuria and requirement for blood pressure medications and insulin dose were noted during followup. Results: Eight patients (1%) (mean age 48 years: there were 5 men) underwent bariatric procedures (gastric banding -four, gastric sleeve -three and gastric bypass -one). Mean follow-up duration was 10 years. During follow-up a trend towards reduction was noted in weight (kg) (163 -115 p = 0.01), proteinuria (g/mol) (381 -65 p = 0.302), HbA 1c (%) (8.1 to 6.7 p = 0.03) and total cholesterol (mmol/L) (4.7 to 4.0 p = 0.33). The estimated glomerular filtration rate (eGFR) (mL/min/1.73m2 ) did not change significantly (58.1 -54.1 p = 0.426). Reductions of anti-hypertensive medications (1.8 -0.75, p = 0.08) and insulin dose (IU) (61.3 -25 p = 0.37) were also noted. One patient developed complications requiring removal of the gastric band. One patient progressed to end-stage renal disease. Conclusions: There was significant weight loss leading to improvement in multiple metabolic parameters. There was a trend towards a slow progression of CKD post-bariatric surgery during the follow-up. Although the numbers are small bariatric procedures appears to have a significant role in the management of obesity associated with CKD and related metabolic conditions. Key words: Obesity, Renal insufficiency chronic, Bariatric surgery