Gastric Bypass Surgery and Measured and Estimated GFR in Women

Lieske, John C.; Collazo–Clavell, Maria L.; Sarr, Michael G.; Rule, Andrew D.; Bergstralh, Eric J.; Kumar, Rajiv

doi:10.1053/j.ajkd.2014.06.016

Cited by 35 publications

(26 citation statements)

References 7 publications

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“… 33 Mean unindexed mGFR significantly decreased from 153 to 123 ml/min, but because body surface area (BSA) also decreased from 2.33 m 2 to 1.93 m 2 , there was no change in mGFR indexed to BSA (114 to 110 ml/min/1.73 m 2 ). Similar findings have been seen in other studies measuring GFR or creatinine clearance in individuals with preserved kidney function 34, 35, 36, 37, 38, 39. Since nephron number is fixed at birth, a decrease in unindexed GFR in this high range may be interpreted as improvement in single nephron glomerular hyperfiltration 34, 40.…”

Section: Overview Of Bariatric Surgery Typessupporting

confidence: 86%

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Bariatric Surgery and Kidney-Related Outcomes

Chang

Grams

Navaneethan

2017

Kidney International Reports

112

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The prevalence of severe obesity in both the general and the chronic kidney disease (CKD) populations continues to rise, with more than one-fifth of CKD patients in the United States having a body mass index of ≥35 kg/m2. Severe obesity has significant renal consequences, including increased risk of end-stage renal disease (ESRD) and nephrolithiasis. Bariatric surgery represents an effective method for achieving sustained weight loss, and evidence from randomized controlled trials suggests that bariatric surgery is also effective in improving blood pressure, reducing hyperglycemia, and even inducing diabetes remission. There is also observational evidence suggesting that bariatric surgery may diminish the long-term risk of kidney function decline and ESRD. Bariatric surgery appears to be relatively safe in patients with CKD, with postoperative complications only slightly higher than in the general bariatric surgery population. The use of bariatric surgery in patients with CKD might help prevent progression to ESRD or enable selected ESRD patients with severe obesity to become candidates for kidney transplantation. However, there are also renal risks in bariatric surgery, namely, acute kidney injury, nephrolithiasis, and, in rare cases, oxalate nephropathy, particularly in types of surgery involving higher degrees of malabsorption. Although bariatric surgery may improve long-term kidney outcomes, this potential benefit remains unproved and must be balanced with potential adverse events.

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Section: Overview Of Bariatric Surgery Typessupporting

confidence: 86%

“…Loss of muscle mass with massive weight loss might result in overestimation of eGFR after bariatric surgery 35, 36, 50. Friedman et al.…”

Section: Overview Of Bariatric Surgery Typesmentioning

confidence: 99%

Bariatric Surgery and Kidney-Related Outcomes

Chang

Grams

Navaneethan

2017

Kidney International Reports

112

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“…In addition, we cannot exclude the hypothesis that differences in LBM may cause differences in mGFR. 10 Overall, these results provide an explanation for the novel finding in MESA-Kidney 4 and contribute to the body of knowledge about the role of indexing and adjusting mGFR by measures of body size and composition. Further study is necessary to determine the usefulness of adjusting mGFR by LBM in clinical practice.…”

Section: Research Letter Effects Of Body Size and Composition On Sex supporting

confidence: 53%

Effects of Body Size and Composition on Sex Differences in Measured GFR in a US Community-Based Older Cohort (MESA-Kidney)

Abraham

Shafi

Tighiouart

et al. 2018

American Journal of Kidney Diseases

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Murphy et al 1 state that patients with autosomal dominant polycystic kidney disease (ADPKD) of childbearing potential could benefit from preimplantation genetic diagnosis (PGD) counseling. This benefit may extend to patients with ADPKD outside North America; however, current circumstances in other countries such as China make it challenging or impossible to obtain. Although ADPKD affects about 1.5 million people in China, 2 financial barriers prohibit access to PGD and counseling despite patients' desire for it. In our hospital, of the 102 patients with ADPKD, 91% favor the possibility of PGD, but it is not reimbursed by Chinese national health care and most patients cannot afford it. In China, the cost for in vitro fertilization

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“…However, this effect can be jeopardized by the concomitant loss of muscle mass. Indeed, studies have reported that PCr‐based GFR estimation after weight loss overestimates renal function . Hence, the relevance of GFR indexation for the comparison of renal function after weight loss has been questioned .…”

Section: Discussionmentioning

confidence: 99%

Estimated Glomerular Filtration Rate Bias in Participants with Severe Obesity Regardless of Deindexation

Guebre-Egziabher

Brunelle

Thomas

et al. 2019

Obesity

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Objective Morbid obesity is associated with a higher independent risk of chronic kidney disease (CKD). Estimated glomerular filtration rate (eGFR) has been evaluated in a limited number of study participants with severe obesity. Methods A total of 706 measured GFR (mGFR) results from 598 participants with obesity (BMI ≥ 35 kg/m2) were retrospectively collected. The performance of the Modification of Diet in Renal Disease (MDRD) equation, Chronic Kidney Disease‐Epidemiology (CKD‐EPI) equation, and deindexed eGFR were compared with mGFR from the gold standard technique (inuline or iohexol), adjusted (mGFRr) or nonadjusted (mGFR) to body surface area. Absolute bias, precision, and accuracy were calculated. Results Mean mGFRr (58 ± 31 mL/min/1.73 m2) was significantly different from CKD‐EPI and MDRD (P < 0.001). Mean mGFR (nonindexed) (70 ± 40 mL/min) was significantly higher than mGFRr (P < 0.001). eGFR showed important biases and low accuracies for CKD‐EPI and MDRD (10.7 ± 10.7 and 12.2 ± 13.7 mL/min/1.73 m2; 78% vs. 75% respectively). Deindexation worsened bias and accuracy 30% (percentage of GFR estimates within 30% of mGFRr or mGFR) between eGFR and mGFR. Conclusions eGFR overestimates mGFR and is associated with important biases and inaccuracies in patients with severe obesity, and deindexing eGFR worsens the overestimation. These findings may have important implications in examining kidney function in patients with obesity.

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Gastric Bypass Surgery and Measured and Estimated GFR in Women

Cited by 35 publications

References 7 publications

Bariatric Surgery and Kidney-Related Outcomes

Bariatric Surgery and Kidney-Related Outcomes

Effects of Body Size and Composition on Sex Differences in Measured GFR in a US Community-Based Older Cohort (MESA-Kidney)

Estimated Glomerular Filtration Rate Bias in Participants with Severe Obesity Regardless of Deindexation

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