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Severe Chronic Kidney Disease Is Associated with a Lower Efficiency of Bariatric Surgery

  • Boris HanselEmail author
  • Konstantinos Arapis
  • Diana Kadouch
  • Severine Ledoux
  • Muriel Coupaye
  • Simon Msika
  • François Vrtovsnik
  • Michel Marre
  • Anne Boutten
  • Blandine Cherifi
  • Sophie Cambos
  • Marie Beslay
  • Rodi Courie
  • Ronan Roussel
Original Contributions
  • 60 Downloads

Abstract

Background

Obesity is a risk factor for chronic kidney disease (CKD) and a relative contraindication for renal transplantation. Bariatric surgery (BS) is an option to address this issue but we hypothesize that severe CKD is associated with a loss of efficacy of BS which could justify recommending it at an earlier stage of the CKD.

Methods

A retrospective study (n = 101 patients) to test primarily for differences in weight loss at 6 and 12 months according to estimated glomerular filtration rate categories (eGFR < 30 including patients on dialysis, 30–60, 60–90, and ≥ 90 ml/min/1.73 m2) was performed with multivariate analysis adjusted for sex, age, BMI, surgical procedure, and diabetes. We used a second method to confirm our hypothesis comparing weight loss in patients with stage 4–5 CKD (eGFR < 30 ml/min/1.73 m2, n = 17), and matched controls with eGFR ≥ 90 ml/min/1.73 m2.

Results

In the first comparison, the multivariate analysis showed a significant positive association between eGFR and weight loss. However, after exclusion of the subgroup of patients with eGFR < 30 ml/min/1.73 m2, the difference between groups was no more significant. In addition, percent total weight loss (%TWL) was significantly lower in patients with severe CKD compared to controls: − 15% vs − 23% at 6 months (p < 0.01); − 17% vs − 27% at 12 months (p < 0.01). The percent excess weight loss at 1 year reached 47% in patients with stage 4–5 CKD and 68% in controls subjects (p < 0.01). Surgery was a success at 12 months (weight loss > 50% of excess weight) in 38% of advanced CKD and 88% of controls (p < 0.01).

Conclusion

The efficacy of BS was reduced in patients with advanced CKD. These results support early BS in patients with early-to-moderate CKD.

Keywords

Chronic kidney disease stages Weight loss Benefit/risk ratio Roux-en-Y gastric bypass Sleeve gastrectomy 

Abbreviations

INSERM

Institut National de la Santé et de la Recherche Médicale

HUPNVS

Hôpitaux Universitaires Paris-Nord Val de Seine

AP-HP

Assistance Publique-Hôpitaux de Paris

Notes

Compliance with Ethical Standards

Conflict of Interest

Dr. Hansel reports grants from Amgen, Sanofi, personal fees from Sanofi, AMGEN, Novo Nordisk, Smartsante, Jalma, and MXS, outside the submitted work;

Dr. Arapis has nothing to disclose.

Dr. Kadouch has nothing to disclose.

Dr. Ledoux has nothing to disclose.

Dr. Coupaye has nothing to disclose.

Dr. Msika has nothing to disclose.

Dr. Vrtovsnik has nothing to disclose.

Dr. Marre reports grants and personal fees from Novo Nordisk, personal fees from Servier, personal fees from Merck, personal fees from Lilly, personal fees from Sanofi, and personal fees from Abbott, outside the submitted work;

Dr. Boutten has nothing to disclose.

Dr. Cherifi has nothing to disclose.

Dr. Courie has nothing to disclose.

Ms. Beslay has nothing to disclose.

Dr. Coupaye has nothing to disclose.

Dr. Cambos has nothing to disclose.

Dr. Roussel reports grants and personal fees from Sanofi, personal fees from Astra Zeneca, personal fees from Eli Lilly, personal fees from MSD, personal fees from Novo Nordisk, and personal fees from Janssen, outside the submitted work

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Boris Hansel
    • 1
    • 2
    • 3
    Email author
  • Konstantinos Arapis
    • 3
    • 4
  • Diana Kadouch
    • 1
  • Severine Ledoux
    • 2
    • 5
    • 6
  • Muriel Coupaye
    • 5
    • 6
  • Simon Msika
    • 2
    • 4
  • François Vrtovsnik
    • 2
    • 6
    • 7
  • Michel Marre
    • 1
    • 2
    • 3
  • Anne Boutten
    • 8
  • Blandine Cherifi
    • 9
  • Sophie Cambos
    • 9
  • Marie Beslay
    • 1
  • Rodi Courie
    • 10
  • Ronan Roussel
    • 1
    • 2
    • 3
  1. 1.Service d’Endocrinologie, Diabétologie et NutritionHôpital Bichat-Claude Bernard, HUPNVS, AP-HPParisFrance
  2. 2.Université Paris Diderot - Sorbonne Paris CitéParisFrance
  3. 3.INSERM, U-1138, Centre de Recherche des CordeliersParisFrance
  4. 4.Service de chirurgie digestiveHôpital Bichat-Claude Bernard, HUPNVS, AP-HPParisFrance
  5. 5.Service des Explorations fonctionnellesHôpital Louis Mourier, HUPNVS, AP-HPColombesFrance
  6. 6.INSERM U-1149Faculté BichatParisFrance
  7. 7.Service de NéphrologieHôpital Bichat-Claude Bernard, HUPNVS, AP-HPParisFrance
  8. 8.Service de BiochimieHôpital Bichat-Claude Bernard, HUPNVS, AP-HPParisFrance
  9. 9.Service d’Endocrinologie-Nutrition, CHU de Bordeaux, USNHôpital Haut-LévêquePessacFrance
  10. 10.Département d’Hépato-Gastroentérologie et NutritionHôpital Antoine Béclère, AP-HPClamartFrance

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