The Impact of Renal Function on Outcomes of Bariatric Surgery

Turgeon, Nicole A.; Perez, Sebastian D.; Mondestin, Max; Davis, Scott; Lee, Edward; Tata, Sudha; Kirk, Allan D.; Larsen, Christian; Pearson, Thomas C.; Sweeney, John F.

doi:10.1681/asn.2011050476

Cited by 97 publications

(75 citation statements)

References 98 publications

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“…86 In accordance, in a 5-year followup study in 52 obese type 2 diabetic patients who underwent bariatric surgery, diabetic nephropathy resolved in 58%. 87 Turgeon et al 88 reported that, although CKD patients had higher complication rates after bariatric surgery, the absolute incidence of complications remained less than 10%. In our opinion, although there is a somewhat higher risk for complications in CKD patients with morbid obesity and patients at risk for CKD progression, bariatric surgery is an underused treatment option in this population.…”

Section: Treatment Of Obesity In Ckdmentioning

confidence: 99%

Obesity in CKD—What Should Nephrologists Know?

Stenvinkel

Zoccali

İkizler

2013

Journal of the American Society of Nephrology

195

172

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Obesity, the epidemic of the 21st century, carries a markedly increased risk for comorbid complications, such as type 2 diabetes, cancer, hypertension, dyslipidemia, cardiovascular disease, and sleep apnea. In addition, obesity increases the risk for CKD and its progression to ESRD. Paradoxically, even morbid obesity associates with better outcomes in studies of ESRD patients on maintenance dialysis. Because the number of obese CKD and maintenance dialysis patients is projected to increase markedly in developed as well as low-and middle-income countries, obesity is a rapidly emerging problem for the international renal community. Targeting the obesity epidemic represents an unprecedented opportunity for health officials to ameliorate the current worldwide increase in CKD prevalence. Nephrologists need more information about assessing and managing obesity in the setting of CKD. Specifically, more precise estimation of regional fat distribution and the amount of muscle mass should be introduced into regular clinical practice to complement more commonly used practical markers, such as body mass index. Studies examining the effects of obesity on kidney disease progression and other clinical outcomes along with weight management strategies are much needed in this orphan area of research. 24: 172724: -173624: , 201324: . doi: 10.1681 Obesity has emerged as the largest pandemic in near history, with important implications of not only cardiovascular disease (CVD) but also CKD. Recent data from the United States indicate that the incidence and prevalence rates of obesity in maintenance dialysis patients largely exceed the corresponding figures in the general population. 1 A large European population survey documented that a high body mass index (BMI) ranks as one of the strongest risk factors for new-onset CKD. 2 The dimension of the obesity epidemic and the impact of the same epidemic on the kidney demand efforts for understanding the epidemiology and the mechanisms of CKD associated with excess adiposity. It also sets as an absolute public health priority for the development of treatment policies integrated across specialties and general practice to halt this much concerning problem. In this scenario, it is fundamental that nephrologists are updated on current knowledge about obesity in the setting of CKD. However, little attention is still paid to this issue in major nephrology journals. The suboptimal attention to the problem by major sources of dissemination of specialty information suggests that nephrologists may have scarce knowledge of how obesity should be assessed, its epidemiology, mechanisms whereby excess fat mass is conducive to CKD, and management of obesity in the catabolic uremic milieu. 3 J Am Soc Nephrol DEFINITION AND ASSESSMENT OF OBESITYThe most common method for defining obesity is based on BMI (i.e., a person's weight as obese. It should be emphasized that population norms of BMI could be different based on ethnic and racial background (i.e., the proportion of Asian people with a high ...

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Section: Treatment Of Obesity In Ckdmentioning

confidence: 99%

Obesity in CKD—What Should Nephrologists Know?

Stenvinkel

Zoccali

İkizler

2013

Journal of the American Society of Nephrology

195

172

View full text Add to dashboard Cite

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“…Additionally, high rate of post-surgical complications and prolonged hospital stay has been reported in such patients. 2,3 …”

Section: Bariatric Woundsmentioning

confidence: 99%

“…9 Supporting these animal data, human research has confirmed that patients with CKD have a higher rate of wound disruption than individuals with normal GFR. 3 …”

Section: Ckd and Wound Healingmentioning

confidence: 99%

“…Nonhealing wounds present provide an opportunity for infection with multiple microorganisms and sepsis. 22 Recognized risk factors for CUA include diabetes mellitus, poorly controlled secondary hyperparathyroidism along with the use of calcium-based phosphorus binders, obesity, female gender, history of RRT, white ethnicity, 3 low albumin level, and impairment of the vitamin K pathway because of warfarin use. 23 CUA leads to substantial morbidity, prolonged hospitalization, and mortality rates as high as 80%.…”

Section: Uremic Pruritusmentioning

confidence: 99%

“…On one hand, it follows acute traumatic conditions such as crush injury, burns, and post-surgical wounds, [1][2][3] and on the other hand, it arises as simultaneous targeting of skin and kidneys by autoimmune-mediated vasculitis. 4 Chronic kidney disease (CKD) and end-stage renal disease (ESRD) often occur in older people, who have limited physical mobility and predisposition for developing pressure-related wounds.…”

Section: Introductionmentioning

confidence: 99%

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Wound Healing in Patients With Impaired Kidney Function

Maroz

Simman

2013

Journal of the American College of Clinical Wound Specialists

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Renal impairment has long been known to affect wound healing. However, information on differences in the spectrum of wound healing depending on the type of renal insufficiency is limited. Acute kidney injury (AKI) may be observed with different wound types. On one hand, it follows acute traumatic conditions such as crush injury, burns, and post-surgical wounds, and on the other hand, it arises as simultaneous targeting of skin and kidneys by autoimmune-mediated vasculitis. Chronic kidney disease (CKD) and end-stage renal disease (ESRD) often occur in older people, who have limited physical mobility and predisposition for developing pressure-related wounds. The common risk factors for poor wound healing, generally observed in patients with CKD and ESRD, include poorly controlled diabetes mellitus, neuropathy, peripheral vascular disease, chronic venous insufficiency, and aging. ESRD patients have a unique spectrum of wounds related to impaired calcium-phosphorus metabolism, including calciphylaxis, in addition to having the risk factors presented by CKD patients. Overall, there is a wide range of uremic toxins: they may affect local mechanisms of wound healing and also adversely affect the functioning of multiple systems. In the present literature review, we discuss the association between different types of renal impairments and their effects on wound healing and examine this association from different aspects related to the management of wounds in renal impairment patients.

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Effect of weight loss on the estimated glomerular filtration rates of obese patients at risk of chronic kidney disease: the RIGOR‐TMU study

Lin

Lai

Lin

et al. 2019

J cachexia sarcopenia muscle

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Background Weight‐reduction therapies, including bariatric surgery (BS), are standard treatments for severely obese patients with type 2 diabetes; however, the outcomes of these therapies are inconclusive for obese patients with chronic kidney disease (CKD). This study aimed to investigate the effects of BS or non‐surgical interventions on the estimated glomerular filtration rate (eGFR) and to determine whether BS can be recommended for renal function preservation based on body mass index (BMI) and eGFR changes in obese patients with CKD. Methods This study used data from the weight Reduction Intervention on GFR in Obese Patients with Renal Impairment‐Taipei Medical University (TMU) study, which was a large, long‐term, propensity score‐matched cohort study based on clinical data from patients who registered at weight‐reduction centres at TMU and its affiliated hospitals from 2008 to 2016. The patients were stratified according to whether they had undergone BS and into the mild, moderate, and high CKD risk groups using the Kidney Disease: Improving Global Outcomes guidelines. The primary outcome was the eGFR calculated using the Taiwan Chronic Kidney Disease‐Epidemiology Collaboration equation. Cox regression models were used to determine hazard ratios (HRs) for eGFR decreases ≥25%. Results A total of 4332 obese patients were enrolled in this study. After propensity score matching, 1620 patients, including 60.2% women, with a mean age of 36.5 (9.9) years were divided into BS or non‐surgery groups ( n = 810 per group). The overall mean eGFRs increased by 4.4 (14) mL/min·1.73 m 2 and decreased by 6.4 (16.0) mL/min·1.73 m 2 in the BS and non‐surgery groups, respectively. The decrease in BMI in the BS and non‐surgery groups were 2.5 and 1.3 kg/m 2 , respectively. In the moderate/high CKD risk BS group, a significant correlation was evident between an increased eGFR and a reduced BMI (Spearman's correlation −0.229, P < 0.001). The Cox regression analysis showed that the BS group had a significantly lower risk of an eGFR decline ≥25% at 12 months [adjusted HR (aHR) 0.47, P = 0.03). After BS, obese patients with hypertension or albuminuria had significantly lower risks of eGFR declines ≥25% (aHR 0.37, P = 0.02 and aHR 0.13, P = 0.0018, respectively). Conclusions Bariatric surgery was associated with eGFR preservation in all obese patients and, particularly, in those with moderate‐to‐high CKD risks. A longer term outcome study is warranted to determine the benefits of BS for CKD patients.

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The Impact of Renal Function on Outcomes of Bariatric Surgery

Cited by 97 publications

References 98 publications

Obesity in CKD—What Should Nephrologists Know?

Obesity in CKD—What Should Nephrologists Know?

Wound Healing in Patients With Impaired Kidney Function

Effect of weight loss on the estimated glomerular filtration rates of obese patients at risk of chronic kidney disease: the RIGOR‐TMU study

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