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Renal Function and Remission of Hypertension After Bariatric Surgery: a 5-Year Prospective Cohort Study

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Abstract

Purpose

This study examines the effect of Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB) on renal function for at least 5 years post-operatively in a tertiary referral center for bariatric surgery.

Materials and Methods

This prospective cohort study of patients undergoing RYGB and LAGB measured renal function, blood pressure, and diabetes status pre-operatively and then 1 and 5 years post-operatively. Renal function was assessed using the Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), and Cockcroft-Gault formulae. Hypertension and diabetes were defined by the European Society of Hypertension and European Society of Cardiology joint guidelines and American Diabetes Association guidelines, respectively. A sub-group who had completed 10 years post-operative follow-up was also included.

Results

Estimated glomerular filtration rate (eGFR) increased over 5 years after RYGB (N = 190; 94 ± 2 mL/min/1.73 m2 to 102 ± 22 mL/min/1.73 m2, p = 0.01) and LAGB (N = 271; 88 ± 1 to 93 ± 22 mL/min/1.73 m2, p = 0.02). In a sub-group with up to 10 years post-operative date, this trend was maintained. In patients with renal impairment, eGFR improved over 5 years (52 ± 2 to 68 ± 7 mL/min/1.73 m2, p = 0.01).

Remission of hypertension was greater after RYGB than LAGB at 1 year (32 vs. 16 %, p = 0.008) and at 5 years post-operatively (23 vs. 11 %, p = 0.02).

Conclusions

Bariatric surgery stabilizes eGFR post-operatively for at least 5 years. In a sub-group with renal impairment, eGFR is increased in the first post-operative year and this is maintained for up to 5 years. RYGB is an effective procedure in achieving blood pressure control.

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Acknowledgments

This work was supported by grants from European Genomic Institute for Diabetes (ANR-10-LABX-46), and Fondation Coeur et Artères to FP. ClR is supported by the Science Foundation Ireland (ref: 12/YI/B2480). KJN is supported by the Irish Endocrine Society and by the MSD Endocrine Research Bursary from the Royal College of Physicians of Ireland.

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Authors and Affiliations

  1. Diabetic Complication Research Centre, UCD Conway Institute, School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland

    Karl J. Neff & Carel W. le Roux

  2. General and Endocrine Surgery, Lille University Hospital, Lille, France

    Gregory Baud, Violeta Raverdy, Robert Caiazzo, Helene Verkindt & François Pattou

  3. Inserm U 1190, European Genomic Institute for Diabetes, Lille University, Lille, France

    Gregory Baud, Violeta Raverdy, Robert Caiazzo, Helene Verkindt & François Pattou

  4. Gastrosurgical Laboratory, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Carel W. le Roux

  5. Nephrology, Lille University Hospital, Lille, France

    Christian Noel

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  1. Karl J. Neff
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Correspondence to François Pattou.

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The authors declare that they have no conflict of interest.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in the study.

Statement of Human Rights

This study was approved by the appropriate institutional review board and was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Neff, K.J., Baud, G., Raverdy, V. et al. Renal Function and Remission of Hypertension After Bariatric Surgery: a 5-Year Prospective Cohort Study. OBES SURG 27, 613–619 (2017). https://doi.org/10.1007/s11695-016-2333-7

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