Effect of weight loss after bariatric surgery on kidney function in a multiethnic Asian population

Ngoh, Clara Lee Ying; So, Jimmy Bok Yan; Tiong, Ho Yee; Shabbir, Asim; Teo, Boon Wee

doi:10.1016/j.soard.2015.07.003

Cited by 20 publications

(6 citation statements)

References 28 publications

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“…In this subgroup, BS resulted in an improvement of renal function preventing from progressive eGFR decline as usually seen in obesity-related hyperfiltration. Similar results were found in a multiethnic Asian population, where reversal of both, hypo -and hyperfiltration, could be achieved 1 year after BS [22]. As discussed in a systematic review by Bilha et al, the beneficial effects of BS in patients with hypofiltration are of particular interest [7].…”

Section: Discussionsupporting

confidence: 65%

Bariatric Surgery Is Protective Against Renal Function Decline in Severely Obese Patients in the Long-Term

et al. 2020

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Purpose This study aims to assess the long-term renal effects of bariatric surgery (BS) in severely obese patients over a follow-up period of up to 11 years. Materials and Methods In a retrospective cohort study including 102 patients, patients were stratified by eGFR at baseline and divided into three groups: (1) reduced, (2) normal, and (3) increased filtration rate. Adjustments for age- and sex-related decline in eGFR were performed. We used uni- and multivariate regression analysis to identify variables that were thought to determine change in eGFR. Results Over a median follow-up of 8.5 years (interquartile range 2.7), eGFR declined from 96.1 ± 20.7 to 84.9 ± 21.0 ml/min (p < 0.001). Among patients with (1), eGFR remained stable (69.1 ± 19.3 ml/min). Among patients with (2), eGFR declined from 99.7 ± 13.3 ml/min to 88.7 ± 19.4 ml/min (p < 0.001). Among patients with (3), eGFR decreased to normal levels (94.2 ± 17.7 ml/min, p < 0.001). Age- and sex-adjusted eGFR increased (6.4 ± 14.4 ml/min; p < 0.05) among patients with reduced filtration rate. Among patients with normal filtration rate, adjusted eGFR remained stable during follow-up (−1.3 ± 15.2 ml/min; n.s.). Among patients with increased filtration rate, adjusted eGFR decreased and remained within the normal range (−13.2 ± 12.2 ml/min; p < 0.001). Change in eGFR showed a negative correlation with eGFR at baseline (B = −0.31; p < 0.001), change in LDL-cholesterol (B = -0.09; p < 0.05), and a negative correlation with treatment requiring hypertension (B = -9.36; p = 0.001). Conclusion BS is protective against renal function decline in severely obese patients in the long term.

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Section: Discussionsupporting

confidence: 65%

Bariatric Surgery Is Protective Against Renal Function Decline in Severely Obese Patients in the Long-Term

et al. 2020

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“…Влияние на почечную функцию, как отметили авторы, может быть как прямым следствием потери массы тела, так и косвенным эффектом за счет устранения или уменьшения влияния вышеупомянутых коморбидных состояний. Подобное улучшение СКФ при морбидном ожирении с ХБП 3-5-й стадий в течение года после бариатрических операций продемонстрировано и другими авторами как в европейской, так и в азиатской популяции пациентов [45,46].…”

Section: изменение скорости клубочковой фильтрации в ближайшие сроки после операцииunclassified

Nephrological aspects of surgical weight correction in morbid obesity

Bobkova¹,

Gussaova²,

Stavrovskaya³

et al. 2018

Terapevticheskii arkhiv

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Obesity, including morbid obesity, is a growing worldwide problem. The adverse effect of obesity on the kidneys is associated with the development of comorbid conditions, such as insulin resistance (IR), metabolic syndrome (MS), diabetes mellitus (DM), arterial hypertension (AH), which are the recognized risk factors of chronic kidney disease (СKD). Obesity also causes direct kidney damage with the development of non-immune focal segmental glomerulosclerosis. The leading pathophysiological mechanisms of kidney damage in obesity are intrarenal hemodynamic disorders with the formation of hyperfiltration and damaging effects of adipokines produced by adipose tissue. Bariatric surgery (BS) has taken a leading position in the treatment of morbid obesity, demonstrating its effectiveness not only in long-term weight loss, but also in the correction of IR, MS, DM, AH. Nephroprotective effect of significant and persistent weight loss is caused by the elimination of hyperfiltration and damaging effect of adipokines. Results of the observational studies of the immediate and long-term effects of BS have demonstrated positive renal outcomes, in particular, the decrease in albuminuria/proteinuria, the improvement or stabilization of glomerular filtration rate, the delay of end-stage renal failure development; surgical correction of body weight in dialysis patients with morbid obesity lets them realize subsequent kidney transplantation. Large, randomized prospective studies with a longer follow-up are needed; analysis of the long-term renal consequences of BS in obesity patients with pre-existing renal impairment, including dialysis patients, is required; stratification of the BS risk of renal complications (acute kidney damage, nephrolithiasis, nephrocalcinosis) and effective strategy for managing these risks need to be developed.

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“…Due to 3 studies [ 26 , 39 , 43 ] using CrCl, eGFR with and without adjustment for BSA, the continuous data could not be combined in the meta-analysis of CKD III. Furthermore, 9 studies of 631 patients with continuous data [ 19 , 20 , 23 , 26 , 31 , 32 , 35 , 44 , 52 ] and 6 studies of 514 patients with dichotomous data [ 23 , 29 , 32 , 33 , 35 , 53 ] were included in the meta-analysis of hyperfiltration.…”

Section: Resultsmentioning

confidence: 99%

Effects of Bariatric Surgery on Renal Function in Obese Patients: A Systematic Review and Meta Analysis

Zou

et al. 2016

PLoS ONE

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BackgroundObesity is an independent risk factor of development and progression of chronic kidney disease (CKD). Data on the benefits of bariatric surgery in obese patients with impaired kidney function have been conflicting.ObjectiveTo explore whether there is improvement in glomerular filtration rate (GFR), proteinuria or albuminuria after bariatric surgery.MethodsWe comprehensively searched the databases of MEDLINE, Embase, web of science and Cochrane for randomized, controlled trials and observational studies that examined bariatric surgery in obese subjects with impaired kidney function. Outcomes included the pre- and post-bariatric surgery GFR, proteinuria and albuminuria. In obese patients with hyperfiltration, we draw conclusions from studies using measured GFR (inulin or iothalamate clearance) unadjusted for BSA only. Study quality was evaluated using the Newcastle-Ottawa Scale.Results32 observational studies met our inclusion criteria, and 30 studies were included in the meta-analysis. No matter in dichotomous data or in dichotomous data, there were statistically significant reduction in hyperfiltration, albuminuria and proteinuria after bariatric surgery.LimitationsThe main limitation of this meta-analysis is the lack of randomized controlled trials (RCTs). Another limitation is the lack of long-term follow-up.ConclusionsBariatric surgery could prevent further decline in renal function by reducing proteinuria, albuminuria and improving glomerular hyperfiltration in obese patients with impaired renal function. However, whether bariatric surgery reverses CKD or delays ESRD progression is still in question, large, randomized prospective studies with a longer follow-up are needed.

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Effect of weight loss after bariatric surgery on kidney function in a multiethnic Asian population

Cited by 20 publications

References 28 publications

Bariatric Surgery Is Protective Against Renal Function Decline in Severely Obese Patients in the Long-Term

Bariatric Surgery Is Protective Against Renal Function Decline in Severely Obese Patients in the Long-Term

Nephrological aspects of surgical weight correction in morbid obesity

Effects of Bariatric Surgery on Renal Function in Obese Patients: A Systematic Review and Meta Analysis

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