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Abstract

Metabolic and bariatric surgery significantly outperforms medical treatment in remitting the dangerous consequences of obesity, diabetes, and related comorbidities. Kidney disease is closely linked to metabolic disease and it is important to understand what the emerging evidence tells us regarding the safety, complications, risk reduction, and physiologic impact metabolic surgery has on overall kidney health and those at risk for renal dysfunction. This chapter will review renal outcomes of bariatric and metabolic surgery, including renal complications after surgery, risk reduction, and changes in kidney function in the short and long term.

Superficially, it might be said that the function of the kidneys is to make urine; but in a more considered view one can say that the kidneys make the stuff of philosophy itself.

—Homer Smith

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References

  1. Nor Hanipah Z, Punchai S, Augustin T, Brethauer SA, Schauer PR, Aminian A. Impact of early postbariatric surgery acute kidney injury on long-term renal function. Obes Surg. 2018;28:3580–5.

    Article  PubMed  Google Scholar 

  2. Wang Y, Chen X, Song Y, Caballero B, Cheskin LJ. Association between obesity and kidney disease: a systematic review and meta-analysis. Kidney Int. 2008;73:19–33.

    Article  CAS  PubMed  Google Scholar 

  3. Chang AR, Grams ME, Navaneethan SD. Bariatric surgery and kidney-related outcomes. Kidney Int Rep. 2017;2:261–70.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Hashimoto Y, Tanaka M, Okada H, et al. Article metabolically healthy obesity and risk of incident CKD. Clin J Am Soc Nephrol. 2015;10:578–83.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Praga M, Morales E. The fatty kidney: obesity and renal disease. Nephron. 2017;136:273–6.

    Article  CAS  PubMed  Google Scholar 

  6. D’agati VD, Kaskel FJ, Falk RJ. Medical progress focal segmental glomerulosclerosis. N Engl J Med. 2011;365:2398–411.

    Article  PubMed  Google Scholar 

  7. Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015;373:2117–28.

    Article  CAS  PubMed  Google Scholar 

  8. Novikov A, Vallon V, Diego S. SGLT2 inhibition in the diabetic kidney-an update HHS Public Access. Curr Opin Nephrol Hypertens. 2016;25:50–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Praga M, Herna Â, Ndez E, Morales E, Pe A, Campos Â, Âa M, Valero A, Martõ Ânez MA, Leo M. Clinical features and long-term outcome of obesity-associated focal segmental glomerulosclerosis. Nephrol Dial Transplant. 2001;1790:98.

    Google Scholar 

  10. Kambham N, Markowitz GS, Valeri AM, Lin J, D’agati VD. Obesity-related glomerulopathy: an emerging epidemic. Kidney Int. 2001;59:1498–509.

    Article  CAS  PubMed  Google Scholar 

  11. Serra A, Romero R, Lopez D, Navarro M, Esteve A, Perez N, Alastrue A, Ariza A. Renal injury in the extremely obese patients with normal renal function. Kidney Int. 2008;73:947–55.

    Article  CAS  PubMed  Google Scholar 

  12. Hanipah ZN, Punchai S, Augustin T, Brethauer SA, Schauer PR, Aminian A. Impact of early postbariatric surgery acute kidney injury on long-term renal function. Obes Surg. 2018;28:3580–5.

    Article  Google Scholar 

  13. Morgan DJR, Ho KM. Acute kidney injury in bariatric surgery patients requiring intensive care admission: a state-wide, multicenter, cohort study. Surg Obes Relat Dis. 2015;11:1300–6.

    Article  PubMed  Google Scholar 

  14. Currie A, Chetwood A, Ahmed AR, Currie A, Chetwood A, Ahmed AR. Bariatric surgery and renal function. Obes Surg. 2011;21:528–39.

    Article  PubMed  Google Scholar 

  15. Sharma SK, McCauley J, Cottam D, et al. Acute changes in renal function after laparoscopic gastric surgery for morbid obesity. Surg Obes Relat Dis. 2006;2:389–92.

    Article  PubMed  Google Scholar 

  16. Glance LG, Wissler R, Mukamel DB, Li Y, Ann Diachun CB, Salloum R, Fleming FJ, Dick AW. PERIOPERATIVE MEDICINE perioperative outcomes among patients with the modified metabolic syndrome who are undergoing noncardiac surgery. Anesthesiology. 2010;113:859.

    Article  PubMed  Google Scholar 

  17. Thakar CV, Worley S, Arrigain S, Yared JP, Paganini EP. Influence of renal dysfunction on mortality after cardiac surgery: modifying effect of preoperative renal function. Kidney Int. 2005;67:1112–9.

    Article  PubMed  Google Scholar 

  18. Uchino S, Kellum J, Bellomo R, et al. Acute renal failure in critically ill patients. JAMA. 2005;294:813–8.

    Article  CAS  PubMed  Google Scholar 

  19. Koppe U, Nitsch D, Mansfield KE, Mathur R, Bhaskaran K, Batterham RL, Smeeth L, Douglas IJ. Long-term effects of bariatric surgery on acute kidney injury: a propensity-matched cohort in the UK Clinical Practice Research Datalink. BMJ Open. 2018;8:1–8.

    Article  Google Scholar 

  20. Hasan Bhatti U, Duffy AJ, Eric Roberts K, Hafeez Shariff A. Nephrolithiasis after bariatric surgery: a review of pathophysiologic mechanisms and procedural risk. Int J Surg. 2016;36:618–23.

    Article  Google Scholar 

  21. Sinha MK, Collazo-Clavell ML, Rule A, Milliner DS, Nelson W, Sarr MG, Kumar R, Lieske JC. Hyperoxaluric nephrolithiasis is a complication of Roux-en-Y gastric bypass surgery. Kidney Int. 2007;72:100–7.

    Article  CAS  PubMed  Google Scholar 

  22. Asplin JR, Coe FL. Hyperoxaluria in kidney stone formers treated with modern bariatric surgery. J Urol. 2007;177:565–9.

    Article  PubMed  Google Scholar 

  23. Durrani O, Morrisroe S, Jackman S, Averch T. Analysis of stone disease in morbidly obese patients undergoing gastric bypass surgery. J Endourol. 2006;20:749–52.

    Article  PubMed  Google Scholar 

  24. Lieske JC, Mehta RA, Milliner DS, Rule AD, Bergstralh EJ, Sarr MG. Kidney stones are common after bariatric surgery. Kidney Int. 2015;87:839–45.

    Article  PubMed  Google Scholar 

  25. Encinosa WE, Bernard DM, Chen C-C, Steiner CA. Healthcare utilization and outcomes after bariatric surgery. Med Care. 2006;44:706–12.

    Article  PubMed  Google Scholar 

  26. Kok DJ, Papapoulos SE, Bijvoet OLM. Crystal agglomeration is a major element in calcium oxalate urinary stone formation. Kidney Int. 1990;37:51–6.

    Article  CAS  PubMed  Google Scholar 

  27. Kok DJ, Papapoulos SE, Bijvoet OLM. Excessive crystal agglomeration with low citrate excretion in recurrent stone-formers. Lancet. 1986;327:1056–8.

    Article  Google Scholar 

  28. Nazzal L, Puri S, Goldfarb DS. Enteric hyperoxaluria: an important cause of end-stage kidney disease. Nephrol Dial Transplant. 2016;31:375–82.

    Article  PubMed  Google Scholar 

  29. Dobbins JW, Binder HJ. Importance of the colon in enteric hyperoxaluria. N Engl J Med. 1977;296:298–301.

    Article  CAS  PubMed  Google Scholar 

  30. Kaufman DW, Kelly JP, Curhan GC, Anderson TE, Dretler SP, Preminger GM, Cave DR. Oxalobacter formigenes may reduce the risk of calcium oxalate kidney stones. J Am Soc Nephrol. 2008;19:1197–203.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Kumar R, Lieske JC, Collazo-Clavell ML, Sarr MG, Olson ER, Vrtiska TJ, Bergstralh EJ, Li X. Fat malabsorption and increased intestinal oxalate absorption are common after Roux-en-Y gastric bypass surgery. Surgery. 2011;149:654–61.

    Article  PubMed  Google Scholar 

  32. Canales BK, Hatch M. Kidney stone incidence and metabolic urinary changes after modern bariatric surgery: review of clinical studies, experimental models, and prevention strategies. Surg Obes Relat Dis. 2014;10:734–42.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Carlos Valezi A, Emilio Fuganti P, Mali Junior J, Daher Delfino V. Urinary evaluation after RYGBP: a lithogenic profile with early postoperative increase in the incidence of urolithiasis. Obes Surg. 2013:1575–80.

    Google Scholar 

  34. Park AM, Storm DW, Fulmer BR, Still CD, Wood GC, Hartle JE. A prospective study of risk factors for nephrolithiasis after Roux-en-Y gastric bypass surgery. J Urol. 2009;182:2334–9.

    Article  CAS  PubMed  Google Scholar 

  35. Agrawal V, Liu XJ, Campfield T, Romanelli J, Enrique Silva J, Braden GL. Calcium oxalate supersaturation increases early after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2014;10:88–94.

    Article  PubMed  Google Scholar 

  36. Requarth JA, Burchard KW, Colacchio TA, Stukel TA, Mott LA, Greenberg ER, Weismann RE. Long-term morbidity following jejunoileal bypass. Arch Surg. 1995;130:318.

    Article  CAS  PubMed  Google Scholar 

  37. Matlaga BR, Shore AD, Magnuson T, Clark JM, Johns R, Makary MA. Effect of gastric bypass surgery on kidney stone disease. J Urol. 2009;181:2573–7.

    Article  PubMed  Google Scholar 

  38. Chen T, Godebu E, Horgan S, Mirheydar HS, Sur RL. The effect of restrictive bariatric surgery on urolithiasis. J Endourol. 2013;27:242–4.

    Article  PubMed  Google Scholar 

  39. Semins MJ, Matlaga BR, Shore AD, Steele K, Magnuson T, Johns R, Makary MA. The effect of gastric banding on kidney stone disease. Urology. 2009:746–9.

    Google Scholar 

  40. Noun R, Skaff J, Riachi E, Daher R, Abi Antoun N, Nasr M. One thousand consecutive mini-gastric bypass: short-and long-term outcome. Obes Surg. 2012:697–703.

    Google Scholar 

  41. Turgeon NA, Perez S, Mondestin M, Scott Davis S, Lin E, Tata S, Kirk AD, Larsen CP, Pearson TC, Sweeney JF. CLINICAL EPIDEMIOLOGY The impact of renal function on outcomes of bariatric surgery. J Am Soc Nephrol. 2012;23:885–94.

    Article  PubMed  Google Scholar 

  42. Mozer AB, Pender Iv JR, Chapman WHH, Sippey ME, Pories WJ, Spaniolas K. Bariatric surgery in patients with dialysis-dependent renal failure. Obes Surg. 2015:2088–92.

    Google Scholar 

  43. Andalib A, Aminian A, Khorgami Z, Navaneethan SD, Schauer PR, Brethauer SA. Safety analysis of primary bariatric surgery in patients on chronic dialysis. Surg Endosc. 2016;30:2583–91.

    Article  PubMed  Google Scholar 

  44. Saleh F, Kim SJ, Okrainec A, Jackson TD. Bariatric surgery in patients with reduced kidney function: an analysis of short-term outcomes. Surg Obes Relat Dis. 2015;11:828–35.

    Article  PubMed  Google Scholar 

  45. Cohen JB, Tewksbury CM, Torres Landa S, Williams NN, Dumon KR. National postoperative bariatric surgery outcomes in patients with chronic kidney disease and end-stage kidney disease. Obes Surg. 2019:975–82.

    Google Scholar 

  46. Sheetz KH, Woodside KJ, Shahinian VB, Dimick JB, Montgomery JR, Waits SA. Trends in bariatric surgery procedures among patients with ESKD in the United States. Clin J Am Soc Nephrol CJN.01480219. 2019.

    Google Scholar 

  47. Cacciola RAS, Pujar K, Ilham MA, Puliatti C, Asderakis A, Chavez R. Effect of degree of obesity on renal transplant outcome. Transpl Proc. 2008;40:3408–12.

    Article  CAS  Google Scholar 

  48. McCullough KP, Morgenstern H, Saran R, Herman WH, Robinson BM. Projecting ESRD incidence and prevalence in the United States through 2030. J Am Soc Nephrol. 2019;30:127–35.

    Article  PubMed  Google Scholar 

  49. Kramer H, Luke A. Obesity and kidney disease: a big dilemma. Curr Opin Nephrol Hypertens. 2007;16:237–41.

    Article  PubMed  Google Scholar 

  50. Friedman AN, Miskulin DC, Rosenberg IH, Levey AS. Demographics and trends in overweight and obesity in patients at time of kidney transplantation. Am J Kidney Dis. 2003;41:480–7.

    Article  PubMed  Google Scholar 

  51. Segev DL, Simpkins CE, Thompson RE, Locke JE, Warren DS, Montgomery RA, Segev D. Obesity impacts access to kidney transplantation. Clin Epidemiol J Am Soc Nephrol. 2008;19:349–55.

    Article  Google Scholar 

  52. Glanton CW, Kao T-C, Cruess D, Agodoa LYC, Abbott KC. CLINICAL NEPHROLOGY-EPIDEMIOLOGY-CLINICAL TRIALS Impact of renal transplantation on survival in end-stage renal disease patients with elevated body mass index. Kidney Int. 2003;63:647–53.

    Article  PubMed  Google Scholar 

  53. Modanlou KA, Muthyala U, Xiao H, Schnitzler MA, Salvalaggio PR, Brennan DC, Abbott KC, Graff RJ, Lentine KL. Bariatric surgery among kidney transplant candidates and recipients: analysis of the United States renal data system and literature review. Transplantation. 2009;87:1167–73.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Al-Bahri S, Fakhry TK, Gonzalvo JP, Murr MM. Bariatric surgery as a bridge to renal transplantation in patients with end-stage renal disease. Obes Surg. 2017;27:2951–5.

    Article  PubMed  Google Scholar 

  55. Gore JL, Pham PT, Danovitch GM, Wilkinson AH, Rosenthal JT, Lipshutz GS, Singer JS. Obesity and outcome following renal transplantation. Am J Transplant. 2006;6:357–63.

    Article  CAS  PubMed  Google Scholar 

  56. Udgiri NR, Kashyap R, Minz M. The impact of body mass index on renal transplant outcomes: a significant independent risk factor for graft failure and patient death. Transplantation. 2003;75:249.

    Article  CAS  PubMed  Google Scholar 

  57. Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes — 5-year outcomes. N Engl J Med. 2017;376:641–51.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Carlsson LM, Sjöholm K, Karlsson C, et al. Long-term incidence of microvascular disease after bariatric surgery or usual care in patients with obesity stratified by baseline glucose status. Lancet Diabetes Endocrinol. 2017;5:271–9.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Aminian A, Daigle CR, Romero-Talamás H, Kashyap SR, Kirwan JP, Brethauer SA, Schauer PR. Risk prediction of complications of metabolic syndrome before and 6 years after gastric bypass. Surg Obes Relat Dis. 2014;10:576–82.

    Article  PubMed  Google Scholar 

  60. Hippisley-Cox J, Coupland C. Predicting the risk of chronic kidney disease in men and women in England and Wales: prospective derivation and external validation of the QKidney®Scores. BMC Fam Pract. 2010;11:49.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Adams TD, Davidson LE, Litwin SE, et al. After 6 years. JAMA. 2012;308:1122–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. Sjöström L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683–93.

    Article  PubMed  Google Scholar 

  63. Stacy Brethauer MA, Aminian A, Romero-Talamás H, et al. Can diabetes be surgically cured?: Long-term metabolic effects of bariatric surgery in obese patients with type 2 diabetes. Ann Surg. 2013;258:628–37.

    Article  PubMed  Google Scholar 

  64. Heneghan HM, Cetin D, Navaneethan SD, Orzech N, Brethauer SA, Schauer PR. Effects of bariatric surgery on diabetic nephropathy after 5 years of follow-up. Surg Obes Relat Dis. 2013;9:7–14.

    Article  PubMed  Google Scholar 

  65. O’Brien R, Johnson E, Haneuse S, et al. Microvascular outcomes in patients with diabetes after bariatric surgery versus usual care. Ann Intern Med. 2018;169:300–10.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Aminian A, Zajichek A, Arterburn DE, Wolski KE, Brethauer SA, Schauer PR, Kattan MW, Nissen SE. Association of metabolic surgery with major adverse cardiovascular outcomes in patients with type 2 diabetes and obesity. JAMA. 2019;322:1271–82.

    Article  PubMed Central  PubMed  Google Scholar 

  67. Funes DR, Blanco DG, Gómez CO, Frieder JS, Menzo EL, Szomstein S, White KP, Rosenthal RJ. Metabolic surgery reduces the risk of progression from chronic kidney disease to kidney failure. Ann Surg. 2019;270:511–8.

    Article  PubMed  Google Scholar 

  68. Douros JD, Tong J, D’Alessio DA. The effects of bariatric surgery on islet function, insulin secretion, and glucose control. Endocr Rev. 2019;40:1394–423.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Batterham RL, Cummings DE. Mechanisms of diabetes improvement following bariatric/metabolic surgery. Diabetes Care. 2016;39:893–901.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Chondronikola M, Harris LLS, Klein S. Bariatric surgery and type 2 diabetes: are there weight loss-independent therapeutic effects of upper gastrointestinal bypass? J Intern Med. 2016;280:476–86.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  71. Rossi MCE, Nicolucci A, Pellegrini F, et al. Obesity and changes in urine albumin/creatinine ratio in patients with type 2 diabetes: the DEMAND study. Nutr Metab Cardiovasc Dis. 2010;20:110–6.

    Article  CAS  PubMed  Google Scholar 

  72. Upala S, Wijarnpreecha K, Congrete S, Rattanawong P, Sanguankeo A. Bariatric surgery reduces urinary albumin excretion in diabetic nephropathy: a systematic review and meta-analysis. Surg Obes Relat Dis. 2016;12:1037–44.

    Article  PubMed  Google Scholar 

  73. Young L, Hanipah ZN, Brethauer SA, Schauer PR, Aminian A. Long-term impact of bariatric surgery in diabetic nephropathy. Surg Endosc. 2019;33:1654–60.

    Article  PubMed  Google Scholar 

  74. Friedman AN, Wang J, Wahed AS, Docherty NG, Fennern E, Pomp A, Purnell JQ, le Roux CW, Wolfe B. The association between kidney disease and diabetes remission in bariatric surgery patients with type 2 diabetes. Am J Kidney Dis. 2019;74:761–70.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Abouchacra S, Chaaban A, Gebran N, Hussein Q, Ahmed M, Bernieh B, Torab F, Kayyal Y, Omary HA, Nagelkerke N. GFR estimation in the morbidly obese pre- and postbariatric surgery: one size does not fit all. Int Urol Nephrol. 2013;45:157–62.

    Article  PubMed  Google Scholar 

  76. Imam TH, Fischer H, Jing B, Burchette R, Henry S, Derose SF, Coleman KJ. Estimated GFR before and after bariatric surgery in CKD. Am J Kidney Dis. 2017;69:380–8.

    Article  PubMed  Google Scholar 

  77. Micic DD, Ramos-Molina B, Stocker CJ, et al. Bariatric surgery modulates urinary levels of microRNAs involved in the regulation of renal function. Front Endocrinol 2019;10:319. www.frontiersin.org.

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Wilson, R., Aminian, A. (2021). Renal Complications After Bariatric Surgery. In: Bhasker, A.G., Kantharia, N., Baig, S., Priya, P., Lakdawala, M., Sancheti, M.S. (eds) Management of Nutritional and Metabolic Complications of Bariatric Surgery. Springer, Singapore. https://doi.org/10.1007/978-981-33-4702-1_10

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