Metabolic Surgery to Treat Obesity in Diabetic Kidney Disease, Chronic Kidney Disease, and End-Stage Kidney Disease; What Are the Unanswered Questions?

Martin, W.; White, James P.; López‐Hernández, Francisco J.; Docherty, Neil G.; Roux, Carel W. le

doi:10.3389/fendo.2020.00289

Cited by 34 publications

(39 citation statements)

References 189 publications

(312 reference statements)

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“…Bariatric surgery in people with obesity and ESKD has the potential to improve access to kidney transplantation and consequently lower mortality attributable to kidney failure [15]. However, the perioperative complications after bariatric surgery remain to be assessed for patients at each progressive stage of CKD.…”

Section: Introductionmentioning

confidence: 99%

The Impact of CKD on Perioperative Risk and Mortality after Bariatric Surgery

et al. 2021

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Background: 20% of patients with chronic kidney disease (CKD) in the United States have a body-mass index (BMI) ≥35 kg/m2. Bariatric surgery reduces progression of CKD to end-stage kidney disease (ESKD), but the risk of perioperative complications remains a concern. Methods: 24-month data spanning 2017-2018 were obtained from the Metabolic and Bariatric Surgery Quality Improvement Program (MBSAQIP) database and analyzed. Surgical complications were assessed based on the length of hospital stay, mortality, reoperation, readmission, surgical site infection (SSI), and worsening of kidney function during the first 30 days after surgery. Results: The 277,948 patients who had primary bariatric procedures were 44±11.9 (mean±SD) years old, 79.6% female, and 71.2% Caucasian. Mean BMI was 45.7±7.6 kg/m2. Compared with patients with an eGFR ≥90 mL/min/BSA, those with stage 5 CKD/ESKD were 1.91 times more likely to be readmitted within 30 days of a bariatric procedure (95% CI, 1.37-2.67; p<0.001). Similarly, length of hospital stay beyond 2 days was 2.05-fold (95% CI, 1.64-2.56; p<0.001) higher and risk of deep incisional surgical site infection was 6.92-fold (95% CI, 1.62-29.52; p=0.009) higher for those with stage 5 CKD/ESKD. Risk of early postoperative mortality increased with declining preoperative eGFR, such that patients with CKD stage 3b were 3.27 (95% CI, 1.82-5.89; p<0.001) times more likely to die compared with those with normal kidney function. However, absolute mortality rates remained relatively low at 0.53% in those with CKD stage 3b. Furthermore, absolute mortality rates were less than 0.5% in those with CKD stages 4 and 5, and these advanced CKD stages were not independently associated with an increased risk of early postoperative mortality. Conclusion: Increased severity of kidney disease was associated with increased complications after bariatric surgery. However, even for the population with advanced CKD, the absolute rates of postoperative complications were low. The mounting evidence for bariatric surgery as a renoprotective intervention in people with and without established kidney disease suggests that bariatric surgery should be considered a safe and effective option for patients with CKD.

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Section: Introductionmentioning

confidence: 99%

The Impact of CKD on Perioperative Risk and Mortality after Bariatric Surgery

et al. 2021

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“…Enhanced integration of diabetes and nephrology care, including earlier referral to nephrology services, can improve renal outcomes for people with diabetes and chronic kidney disease (CKD) 5 . Intentional weight loss strategies, including metabolic surgery, may also reduce the burden of cardiovascular disease and slow renal functional decline in people with type 2 diabetes and CKD [6][7][8] . Given the range of new and efficacious options for the treatment of diabetes and its complications, identifying subgroups at the highest risk of rapid renal functional decline and/or death will help clinicians to appropriately stratify intensification of therapy.…”

Section: Introductionmentioning

confidence: 99%

Parallel assessment of albuminuria and plasma sTNFR1 in people with type 2 diabetes and advanced chronic kidney disease provides accurate prognostication of the risks of renal decline and death

Martin

Tuohy

Doody

et al. 2020

Sci Rep

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Identification of people with diabetes and chronic kidney disease at high-risk of early mortality is a priority to guide intensification of therapy. We aimed to investigate the complementary prognostic value of baseline urine albumin-to-creatinine ratio (uACR) and plasma soluble tumour necrosis factor receptor-1 (sTNFR1) with respect to early mortality and renal functional decline in a population with type 2 diabetes and advanced chronic kidney disease. We measured plasma sTNFR1 in people with type 2 diabetes (HbA1c ≥ 48 mmol/mol) at 2 hospital sites in Dublin between October 15th, 2014 and July 17th, 2015. In a subgroup of patients with advanced chronic kidney disease at baseline (estimated glomerular filtration rate (eGFR) ≤ 60 mL/min/BSA) (n = 118), we collected clinical and longitudinal laboratory data to investigate relationships between sTNFR1 and renal and mortality endpoints by multivariable linear mixed-effects models and Cox proportional hazards regression models. The cohort was 64% male and 97% Caucasian. Mean age was 74 years, with a median type 2 diabetes duration of 16 years. Mean CKD-EPI eGFR was 42 mL/min/BSA and median [IQR] uACR was 3 [11] mg/mmol. Twenty-three (39%) people in quartiles 3 and 4 for plasma sTNFR1 died over 4-year follow-up. After adjustment for clinical variables, annual CKD-EPI eGFR decreased by − 0.56 mL/min/BSA/year for each logarithm unit increase in baseline uACR, corresponding to an annual loss of renal function of 3% per year. Furthermore, elevated uACR, but not sTNFR1, increased the risk of ≥ 40% decline in CKD-EPI eGFR (HR 1.5, p = 0.001) and doubling of serum creatinine (HR 2.0, p < 0.001). Plasma sTNFR1 did not predict a more negative trajectory in eGFR slope. However, for those people in quartiles 3 and 4 for plasma sTNFR1, an increased risk of incident mortality was detected (HR 4.9, p = 0.02). No such association was detected for uACR. In this elderly cohort of patients with type 2 diabetes and chronic kidney disease, sTNFR1 predicted short-to-medium term mortality risk but not risk of progressive renal functional decline. In contrast, parallel assessment of uACR predicted renal functional decline but not mortality, highlighting the complementary prognostic information provided by both parameters.

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“…Kidney transplant has evolved over a period of time as the definite method for patients with end stage kidney disease which is recognized when 85-90% of kidney function has gone; glomerular filtration ratio (GFR) falls <15 and their function is not enough for sustaining life 1 . The manifestations of chronic kidney disease are enormous disturbing all body systems 2 .…”

Section: Introductionmentioning

confidence: 99%

Renal Transplant Related Anaesthesia Experience, Considerations and Practice Overview of Afiu, Rawalpindi

Ahmad

Zafar

Akmal

2021

PAFMJ

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Objective: To describe our experience of renal transplant operations in our institute. Study Design: Prospective observational study. Place and Duration of Study: Department of Anaesthesiology, Armed Forces Institute of Urology, Rawalpindi, from Sep 2016 to Sep 2019. Methodology: A total of 170 living related renal transplants were included in this study. Soda bicarbonate was given intra operatively to recipients according to arterial blood gas results. Blood transfusion was done where indicated. Results: Out of 340 (100 %) patients, 170 (50%) were living related donors and 170 (50%) were transplant recipients General anesthesia was the technique of choice. Three (1.76%) recipients out of 170 were awaked from anesthesia and postponed. Five (2.94%) patients were reopened on the same evening and 2 (1.17%) patients had transplant nephrectomy over a period 1 month. Soda bicarbonate was given to 143 (84.1%) and blood transfusion in 4 (2.35%) transplant recipients where as one patient had anaphylaxis intra-operatively. Conclusion: Living related kidney transplant is the standard transplant procedure in our institute because of non-availability of cadaveric donor. It’s now time that deceased donor program be started in Pakistan due to increased cases of renal failure and decreased living donors.

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Metabolic Surgery to Treat Obesity in Diabetic Kidney Disease, Chronic Kidney Disease, and End-Stage Kidney Disease; What Are the Unanswered Questions?

Cited by 34 publications

References 189 publications

The Impact of CKD on Perioperative Risk and Mortality after Bariatric Surgery

The Impact of CKD on Perioperative Risk and Mortality after Bariatric Surgery

Parallel assessment of albuminuria and plasma sTNFR1 in people with type 2 diabetes and advanced chronic kidney disease provides accurate prognostication of the risks of renal decline and death

Renal Transplant Related Anaesthesia Experience, Considerations and Practice Overview of Afiu, Rawalpindi

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