Abstract
PurposeThis study aims to assess the long-term renal effects of bariatric surgery (BS) in severely obese patients over a follow-up period of up to 11 years.Materials and MethodsIn a retrospective cohort study including 102 patients, patients were stratified by eGFR at baseline and divided into three groups: (1) reduced, (2) normal, and (3) increased filtration rate. Adjustments for age- and sex-related decline in eGFR were performed. We used uni- and multivariate regression analysis to identify variables that were thought to determine change in eGFR.ResultsOver a median follow-up of 8.5 years (interquartile range 2.7), eGFR declined from 96.1 ± 20.7 to 84.9 ± 21.0 ml/min (p < 0.001). Among patients with (1), eGFR remained stable (69.1 ± 19.3 ml/min). Among patients with (2), eGFR declined from 99.7 ± 13.3 ml/min to 88.7 ± 19.4 ml/min (p < 0.001). Among patients with (3), eGFR decreased to normal levels (94.2 ± 17.7 ml/min, p < 0.001). Age- and sex-adjusted eGFR increased (6.4 ± 14.4 ml/min; p < 0.05) among patients with reduced filtration rate. Among patients with normal filtration rate, adjusted eGFR remained stable during follow-up (−1.3 ± 15.2 ml/min; n.s.). Among patients with increased filtration rate, adjusted eGFR decreased and remained within the normal range (−13.2 ± 12.2 ml/min; p < 0.001). Change in eGFR showed a negative correlation with eGFR at baseline (B = −0.31; p < 0.001), change in LDL-cholesterol (B = -0.09; p < 0.05), and a negative correlation with treatment requiring hypertension (B = -9.36; p = 0.001).ConclusionBS is protective against renal function decline in severely obese patients in the long term.
Highlights
Patients with obesity are more likely to develop chronic kidney disease (CKD) and end-stage renal failure [1]
In the present study, we addressed the following questions: (1) Does bariatric surgery (BS) improve renal function in the longterm in patients with class III obesity and (2) what is the impact of variables such as preoperative age, body mass index (BMI), Hemoglobin A1c (HbA1c), Estimated glomerular filtration rate (eGFR), Low-density lipoprotein (LDL)-cholesterol and obesity-related comorbidities?
At visit 1, there were significant reductions in weight (151.6 ± 36.2 versus 109.7 ± 29.0 kg; p < 0.001) and BMI (51.3 ± 9.5 versus 37.1 ± 8.0 kg/m2; p < 0.001), which were maintained at long-term follow-up (111.6 ± 27.8 kg, p < 0.001 and 37.9 ± 8.5 kg/m2, p < 0.001) compared with baseline
Summary
Patients with obesity are more likely to develop chronic kidney disease (CKD) and end-stage renal failure [1]. Obesityinduced intrarenal hemodynamic changes include increased renal plasma flow and glomerular filtration rate (GFR) [2, 3]. In the long-term though, individuals with a body mass index (BMI) greater than 30 kg/m2 have a significant higher risk of glomerular filtration rate decline [6]. Most patients show slow progression of non-nephrotic proteinuria and worsening of renal function, but 10–33% of patients develop end-stage renal failure in the long-term [3]. At-risk patients for a more severe clinical course are those with greater proteinuria, older age and renal dysfunction at onset of obesity-related glomerulopathy (ORG) [2]
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