Abstract
Background
The prevalences of obesity and chronic kidney disease (CKD) have increased simultaneously. Should a pathophysiological relationship exist between the two conditions, bariatric surgery and associated weight loss could be an important intervention in extremely obese individuals to slow the progression of CKD.
Methods
We conducted a retrospective analysis of 25 patients who had undergone biliopancreatic diversion (BPD) surgery for extreme obesity (body mass index >40 kg/m2), with mean follow-up of 4 years. We assessed pre- and post-surgery renal function, body weight and blood pressure (BP) obtained from electronic hospital and primary care records.
Results
There was a significant reduction in mean body weight at 4 years by 50.3 kg (SD = 20.65). The creatinine and estimated glomerular filtration rate (eGFR) also improved significantly: serum creatinine reduced by 16.2 μmol/l (SD = 19.57) while the eGFR improved by 10.6 ml/min/m2 (SD = 15.45). The greatest improvement in eGFR was in the group (n = 7) with eGFR ≤60 ml/min/m2. A subset of patients (n = 11) had evaluable BP readings and had a reduction in BP of 17/10 mmHg (SD = 33/12).
Conclusions
This retrospective study demonstrates a clinically significant improvement in renal function following BPD. Several mechanisms including weight loss could account for the positive impact on renal function. The physiology underlying this improvement requires further study.
Similar content being viewed by others
References
Baskin ML, Ard J, Franklin F, et al. Prevalence of obesity in the United States. Obes Rev. 2005;6(1):5–7.
Flegal KM, Carroll MD, Ogden CL, et al. Prevalence and trends in obesity among US adults, 1999–2008. JAMA. 2010;303(3):235–41.
Coresh J, Selvin E, Stevens LA, et al. Prevalence of chronic kidney disease in the United States. JAMA. 2007;298:2038–47.
Snyder JJ, Foley RN, Collins AJ. Prevalence of CKD in the United States: a sensitivity analysis using the National Health and Nutrition Examination Survey (NHANES) 1999–2004. Am J Kidney Dis. 2009;53:218–28.
Ting SMS, Nair H, Ching I, et al. Overweight, obesity and chronic kidney disease. Nephron Clin Pract. 2009;112:c121–7.
Fox CS, Larson MG, Leip EP, et al. Predictors of new-onset kidney disease in a community-based population. JAMA. 2004;291:844–50.
Kramer H, Luke A, Bidani A, et al. Obesity and prevalent and incident CKD: the hypertension detection and follow-up program. Am J Kidney Dis. 2005;46:587–94.
Gelber RP, Kurth T, Kausz AT, et al. Association between body mass index and CKD in apparently healthy men. Am J Kidney Dis. 2005;46:871–80.
Neter JE, Stam BE, Kok FJ, et al. Influence of weight reduction on blood pressure. A meta-analysis of randomized controlled trials. J Hypertens. 2003;42:878–84.
Weisinger JR, Kempson R, Eldidge L, et al. The nephrotic syndrome: a complication of massive obesity. Ann Intern Med. 1974;81:440–7.
Chagnac A, Weinstein T, Korzets A, et al. Glomerular haemodynamics in severe obesity. Am J Physiol Ren Physiol. 2000;278:817–22.
Kasiske BL, et al. Glomerulosclerosis in patients with massive obesity. Am J Nephrol. 1985;5:45–50.
Jennette JC, Charles L, Grubb W. Glomerulomegaly and focal segmental glomerulosclerosis associated with obesity and sleep apnoea syndrome. Am J Kidney Dis. 1987;10:470–2.
Praga M, Hernandez E, Andres A, et al. Effects of body weight loss and captopril treatment on proteinuria associated with obesity. Nephron. 1995;70:35–41.
Navaneethan SD, Yehnert H, Moustarah F, et al. Weight loss interventions in chronic kidney disease: a systematic review and meta-analysis. Clin J Am Soc Nephrol. 2009;4(10):1565–74. Epub 2009 Sep 17.
Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142(7):547–59.
Levey AS, Bosch JP, Lewis JB, et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999;130(6):461–70.
Schuster DP, Teodorescu M, Mikami D, et al. Effect of bariatric surgery on normal and abnormal renal function. Surg Obes Relat Dis. 2011;7(4):459–64.
Acknowledgments
Dr. Shahrad Taheri is funded by the National Institute for Health Research (NIHR) through the Collaborations for Leadership in Applied Health Research and Care for Birmingham and Black Country (CLAHRC BBC) programme. The views expressed in this publication are not necessarily those of the NIHR, the Department of Health, NHS South Birmingham, University of Birmingham or the CLAHRC BBC Theme 8 Management/Steering Group.
Conflict of Interest
None
Author information
Authors and Affiliations
Corresponding authors
Rights and permissions
About this article
Cite this article
Jose, B., Ford, S., Super, P. et al. The Effect of Biliopancreatic Diversion Surgery on Renal Function—a Retrospective Study. OBES SURG 23, 634–637 (2013). https://doi.org/10.1007/s11695-012-0851-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-012-0851-5