International Urology and Nephrology

, Volume 45, Issue 1, pp 157–162 | Cite as

GFR estimation in the morbidly obese pre- and postbariatric surgery: one size does not fit all

  • Samra Abouchacra
  • Ahmed Chaaban
  • Nicole Gebran
  • Qutaiba Hussein
  • Mohamad Ahmed
  • Bassam Bernieh
  • Fowaz Torab
  • Yasser Kayyal
  • Hanan Al Omary
  • Nico Nagelkerke
Nephrology – Original Paper
First Online:
Received:
Accepted:

Abstract

Background

Glomerular hyperfiltration commonly associated with obesity is expected to improve postbariatric surgery. However, formula-based glomerular filtration rate (GFR) estimation in these patients is limited by body size confounders necessitating use of modified equations, the reliability of which remains uncertain.

Methods

In this study, various GFR-estimating formulae were compared in morbidly obese patients at baseline and postbariatric surgery. Through a retrospective chart review, we identified 220 patients who had undergone this procedure, with over 6-month follow-up, during which major weight reduction was achieved.

Results

A significant decrease in BP and glomerular hyperfiltration was observed, though there was large variability in GFR estimation using the different formulae. Gross over and underestimation was observed which improved with correction for body size confounders especially lean body weight (LBW). Postoperatively, significant attenuation in estimated GFR was demonstrated when LBW or body surface area-adjusted versions were used. In a subgroup of patients with chronic kidney disease, a significant improvement in GFR was seen postoperatively with the LBW-modified formula but there were again inconsistencies when using other equations.

Conclusion

Though clinicians must be critical in the application of GFR estimates to patient care, LBW adjustment appears to be the most practical solution to its estimation in the obese patients. This is particularly true for patients with normal renal function but appears to be also applicable to those with compromised kidney function. Future studies are needed to compare these equations with a gold standard GFR measure as well as to explore whether the renal benefits from bariatric surgery are sustained or seen in more advanced CKD stages.

Keywords

Bariatric surgery GFR estimation Morbid obesity 
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Copyright information

© Springer Science+Business Media, B.V. 2012

Authors and Affiliations

  • Samra Abouchacra
    • 1
  • Ahmed Chaaban
    • 1
  • Nicole Gebran
    • 3
  • Qutaiba Hussein
    • 1
  • Mohamad Ahmed
    • 1
  • Bassam Bernieh
    • 1
  • Fowaz Torab
    • 2
  • Yasser Kayyal
    • 2
  • Hanan Al Omary
    • 4
  • Nico Nagelkerke
    • 5
  1. 1.Department of NephrologyTawam HospitalAl AinUnited Arab Emirates
  2. 2.Department of SurgeryTawam HospitalAl AinUnited Arab Emirates
  3. 3.Department of PharmacyTawam HospitalAl AinUnited Arab Emirates
  4. 4.Department of PhysiologyBaghdad UniversityBaghdadIraq
  5. 5.Department of Biostatistics, Faculty of Medicine and Health SciencesUAE UniversityAl AinUnited Arab Emirates

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