Abstract
Introduction
Weight loss after bariatric surgery improves both blood pressure and glycemic control following surgery. The effect of bariatric surgery on renal function is not well characterized. In this study, we sought to quantify the change in renal function over time following surgery.
Methods
We retrospectively reviewed all patients who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) between 2012 and 2014 at our institution. The glomerular filtration rate (GFR, mL/min) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Body mass index (BMI, kg/m2) and percent weight loss (%WL) were calculated following the surgery.
Results
A total of 149 patients who underwent bariatric surgery were included in this study: LRYGB (n = 86 and LSG (n = 63). In LRYGB group, baseline BMI (kg/m2, ±SD) and GFR (mL/min, ±SD) were 48.5 ± 6.8 and 94.7 ± 23.8, respectively. In comparison, BMI and GFR were 49.1 ± 11.9 kg/m2 and 93.1 ± 28.0 mL/min in the LSG group, respectively. Over the follow-up period (19.89 ± 10.93 months), the patients who underwent LRGYB lost a larger percentage of weight as compared to those in the LSG group (29.9 ± 11.7% vs 22.3 ± 10.7%; p = <0.0001). Overall, GFR improved in both LRYGB (101.0 ± 25.8 mL/min) and LSG groups (97.9 ± 25.8 mL/min) and was not significantly different between the two groups. Of patients with a GFR < 90 mL/min prior to weight loss surgery (n = 62), 42% had improvement of their GFR to > 90 mL/min postoperatively (p < 0.001). There was no relationship between weight loss percentage and GFR improvement (p = 0.8703).
Conclusions
Bariatric surgery was associated with improvement in postoperative renal function at almost two years following surgery but was not different for LRYGB versus LSG. The gain in GFR was independent of percentage of weight lost suggesting an alternate mechanism in the improvement of renal function other than weight loss alone.
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References
Schauer PR, Bhatt DL, Kirwan JP et al (2017) Bariatric surgery versus intensive medical therapy for diabetes—5-year outcomes. N Engl J Med 376(7):641–651
Courcoulas AP, Christian NJ, Belle SH et al (2013) Weight change and health outcomes at three years after bariatric surgery among patients with severe obesity. JAMA 310(22):2416–2425
Navaneethan SD, Yehnert H (2009) Bariatric surgery and progression of chronic kidney disease. Surgery Obes Relat Dis 5(6):662–665
Zhou X, Li L, Kwong JS, Yu J, Li Y, Sun X (2016) Impact of bariatric surgery on renal functions in patients with type 2 diabetes: systematic review of randomized trials and observational studies. Surgery Obes Relat Dis 12(10):1873–1882
Neff KJ, Frankel AH, Tam FW, Sadlier DM, Godson C, le Roux CW (2013) The effect of bariatric surgery on renal function and disease: a focus on outcomes and inflammation. Nephrol Dial Transpl 28(Suppl 4):iv73–iv82
Luaces M, Martinez-Martinez E, Medina M et al (2012) The impact of bariatric surgery on renal and cardiac functions in morbidly obese patients. Nephrol Dial Transpl. 27(Suppl 4):iv53–iv57
Clerte M, Wagner S, Carette C et al (2017) The measured glomerular filtration rate (mGFR) before and 6 months after bariatric surgery: a pilot study. Nephrol Therapeut 13(3):160–167
Serpa Neto A, Bianco Rossi FM, Dal Moro Amarante R, Alves Buriti N, Cunha Barbosa Saheb G, Rossi M (2009) Effect of weight loss after Roux-en-Y gastric bypass, on renal function and blood pressure in morbidly obese patients. J Nephrol 22(5):637–646
Navarro-Diaz M, Serra A, Romero R et al (2006) Effect of drastic weight loss after bariatric surgery on renal parameters in extremely obese patients: long-term follow-up. J Am Soc Nephrol 17(12 Suppl 3):S213–S217
Esteban Varela J, Nguyen NT (2015) Laparoscopic sleeve gastrectomy leads the U.S. utilization of bariatric surgery at academic medical centers. Surg Obes Relat Dis 11(5):987–990
Khan S, Rock K, Baskara A, Qu W, Nazzal M, Ortiz J (2016) Trends in bariatric surgery from 2008 to 2012. Am J Surg 211(6):1041–1046
Maciejewski ML, Arterburn DE, Van Scoyoc L et al (2016) Bariatric surgery and long-term durability of weight loss. JAMA Surg 151(11):1046–1055
Peterli R, Wolnerhanssen BK, Vetter D et al (2017) Laparoscopic sleeve gastrectomy versus roux-Y-gastric bypass for morbid obesity-3-year outcomes of the prospective randomized swiss multicenter bypass or sleeve study (SM-BOSS). Ann Surg 265(3):466–473
Levey AS, Stevens LA, Schmid CH et al (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150(9):604–612
Demirovic JA, Pai AB, Pai MP (2009) Estimation of creatinine clearance in morbidly obese patients. Am J Health Syst Pharm 66(7):642–648
Hou CC, Shyu RS, Lee WJ, Ser KH, Lee YC, Chen SC (2013) Improved renal function 12 months after bariatric surgery. Surg Obes Relat Dis 9(2):202–206
Abou-Mrad RM, Abu-Alfa AK, Ziyadeh FN (2013) Effects of weight reduction regimens and bariatric surgery on chronic kidney disease in obese patients. Am J Physiol Renal Physiol 305(5):F613–F617
Currie A, Chetwood A, Ahmed AR (2011) Bariatric surgery and renal function. Obes Surg 21(4):528–539
Kim EY, Kim YJ (2016) Does bariatric surgery really prevent deterioration of renal function? Surg Obes Relat Dis 12(4):856–861
Fenske WK, Dubb S, Bueter M et al (2013) Effect of bariatric surgery-induced weight loss on renal and systemic inflammation and blood pressure: a 12-month prospective study. Surg Obes Relat Dis 9(4):559–568
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Drs. Carla Holcomb, Lauren Goss, Amar Almehmi, Jayleen Grams, and Britney Corey have no conflicts of interest or financial ties to disclose.
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Holcomb, C.N., Goss, L.E., Almehmi, A. et al. Bariatric surgery is associated with renal function improvement. Surg Endosc 32, 276–281 (2018). https://doi.org/10.1007/s00464-017-5674-y
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DOI: https://doi.org/10.1007/s00464-017-5674-y