Effect of Drastic Weight Loss after Bariatric Surgery on Renal Parameters in Extremely Obese Patients

Abstract

Obesity is a health problem that is reaching epidemic proportions. Extreme obesity (body mass index [BMI] >40 kg/m2 ) is a type of obesity that usually does not respond to medical treatment, with surgery being the current treatment of choice. Extreme obesity is associated with cardiovascular disease, type 2 diabetes, dyslipidemia, and hypertension. Recently, obesity has been related with high rate of renal lesions, but renal function and renal parameters in extreme obesity scarcely are documented. The objective of this study was to evaluate the effect of weight loss after bariatric surgery (BS) on BP, renal parameters, and renal function in 61 extremely obese (EO) patients after 24 mo of follow-up. A total of 61 EO adults (37 women) were studied prospectively before and 24 mo after surgery. Control subjects were 24 healthy, normal-weight adults (15 women). Anthropometric, BP, and renal parameters were determined. Presurgery weight, BMI, GFR, 24-h proteinuria, and 24-h albuminuria were higher in the EO patients than in control subjects (P < 0.001). All parameters improved at 12 mo after BS. However, during the second year of follow-up, only 24-h albuminuria (P ‫؍‬ 0.006) and BMI (P ‫؍‬ 0.014) continued to improve. At 24 mo after BS, obesity-related renal alterations considerably improved. This improvement was observed mainly in the first year after surgery, when the majority of weight loss occurred. However, 24-h albuminuria still improves during the second year of follow-up. It is possible that this decrease in 24-h albuminuria is not GFR related but rather is attributable to the persistence of the decrease in BMI and to the improvement of other weight-related metabolic factors.

Obesity-Related Glomerulopathy

“…However, the relationship between weight loss and the outcome of ORG has not been clarified until now. Conclusions from the studies of diabetic nephropathy (9) and unidentified chronic kidney diseases (10,11,16) could be different from those of histologic-proven ORG. And evidence from case reports (17,18) concerning the aggressive treatment of ORG with bariatric surgery is unpersuasive because only a small population was involved.…”

The effect of sodium glucose cotransporter 2 inhibition with empagliflozin on microalbuminuria and macroalbuminuria in patients with type 2 diabetes

“…Therapeutic options for patients with persistent albuminuria in the setting of satisfactory HbA 1c and BP control are limited to changes in lifestyle, such as sodium restriction and weight loss, which are supported by limited evidence and are often difficult to achieve [5,6].…”

Can Bariatric Surgery Be a Surgical Treatment to Prevent the Progression of Chronic Kidney Disease?

“…Baseline kidney disease included glomerular hyperfiltration [13][14][15]19], overt CKD [16][17][18][19][20][21][22][23][24], or end-stage renal disease [16]. There are two studies [16,20] including patients on hemodialysis (HD) treatment.…”

“…The type of surgery performed in these studies is heterogeneous. 4 studies considered Roux-en-Y gastric bypass [15][16][17]23], and 2 studies [20,24] performed sleeve gastrectomy, in which MacLaughlin et al [20] used laparoscopic sleeve gastrectomy, to achieve weight loss. In the study by Hou et al [19], of 233 total patients, 184 patients underwent gastric bypass, 32 patients had sleeve gastrectomy and gastric banding was performed for 14 remaining patients.…”

“…Several studies support the fact that bariatric surgery on morbidly obese patients improve or stabilize their renal function and improve microalbuminuria [13][14][15][16][17][18]. However, surgical intervention has not yet been strongly recommended for the obese patients with CKD.…”