Impact of rapid weight loss after bariatric surgery on the prevalence of arterial hypertension in severely obese patients with chronic kidney disease
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Arterial hypertension (HTN) is one of the most important risk factors for the development and progression of chronic kidney disease (CKD). Rapid weight loss after bariatric interventions has a positive impact on blood pressure levels of hypertensive patients. The aim of our study is to assess the prevalence of HTN in patients with CKD after bariatric surgery (BS).
We retrospectively reviewed severely obese patients who underwent BS from 2010 to 2017. We used guidelines of the American College of Cardiology to define HTN. Only patients meeting ACC criteria and the calculation of estimated glomerular filtration rate (eGFR) using CKD epidemiology collaboration study equation preoperatively and at 12-month follow-up were included in the analysis.
From a total of 2900 patients, 29.13% (845) met the required criteria and had variables for the calculation of eGFR recorded preoperatively. 36.92% (312) had preoperative HTN and s classified as CKD stage ≥ 2. We observed a predominantly female population 63.83% (203) with mean age of 54.10 ± 11.58. Patients preoperatively classified in CKD 2, 3a, and 3b exhibited the greatest prevalence reduction of HTN at 12-month follow-up (68.59%, n = 214 vs. 36.59%, n = 114; 16.67%, n = 52 vs. 6.41%, n = 20; 7.69%, n = 24 vs. 1.28%, n = 4; p < 0.0001). A marked improvement in CKD was also observed along with improvement in HTN. The greatest benefit corresponded to patients classified preoperatively in CKD 2, 3a and 3b. A total of n = 70 (62.5%) patients with HTN were classified as CKD 2 preoperatively compared to n = 55 (49.11%) at 12-month follow-up (p = 0.0436). Similarly, n = 22 (19.64%) patients with HTN were classified preoperatively as CKD 3a compared to n = 7 (6.25%) and n = 12 (10.71%) patients as CKD 3b compared to n = 4 (3.57%) during the same time period (p = 0.0028, p = 0.0379, respectively).
Rapid weight loss after BS significantly reduces prevalence of HTN in all stages of CKD at 12-month follow-up. Additionally, there was a positive impact on classification of CKD at 12-month follow-up.
KeywordsBariatric surgery Weight loss Outcomes Comorbidity remission Hypertension Chronic kidney disease
Compliance with ethical standards
Camila Ortiz‑Gomez, David Romero‑Funes, David Gutierrez‑Blanco, Joel S. Frieder, Maria Fonseca‑Mora, Emanuele Lo Menzo, Samuel Szomstein, and Raul J. Rosenthal have no conflicts of interest or financial ties to disclose.
- 1.Hales CM, Carroll MD, Fryar CD, Ogden CL (2017) Prevalence of obesity among adults and youth: United States, 2015–2016. NCHS Data Brief (288):1–8Google Scholar
- 2.(2000) Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 894:i–xii, 1–253Google Scholar
- 5.Centers for Disease Control and Prevention. Chronic Kidney Disease Surveillance System—United States. Crude percentage with overweight or obesity by age and BMI for 2015–2016. National Health and Nutrition Examination Survery. https://nccd.cdc.gov/CKD/detail.aspx?Qnum=Q144&Strat=Age%2c+BMI#refreshPosition. Accessed 29 Mar 2019
- 7.Hamilton A (2013) Fact sheets: metabolic and bariatric surgery. American Society for Metabolic and Bariatric Surgery, pp. 24–27. https://doi.org/10.1016/j.adaj.2015.06.004
- 11.Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT (2017) 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. J Am Coll Cardiol. https://doi.org/10.1016/j.jacc.2017.11.006 Google Scholar
- 12.Tangri N, Grams ME, Levey AS, Coresh J, Appel LJ, Astor BC, Chodick G, Collins AJ, Djurdjev O, Raina Elley C, Evans M, Garg AX, Hallan SI, Inker LA, Ito S, Jee SH, Kovesdy CP, Kronenberg F, Heerspink HJL, Marks A, Nadkarni GN, Navaneethan SD, Nelson RG, Titze S, Sarnak MJ, Stengel B, Woodward M, Iseki K (2016) Multinational assessment of accuracy of equations for predicting risk of kidney failure ameta-analysis. J Am Med Assoc. https://doi.org/10.1001/jama.2015.18202 Google Scholar
- 14.Gutierrez-Blanco D, Funes-Romero D, Madiraju SG, Perez-Quirante F, Lo Menzo E, Szomstein S, Rosenthal RJ (2018) Reduction of Framingham BMI score after rapid weight loss in severely obese subjects undergoing sleeve gastrectomy: a single institution experience. Surg Endosc 32:1248–1254. https://doi.org/10.1007/s00464-017-5799-z CrossRefGoogle Scholar
- 16.Levey AS, Stevens LA, Schmid CH, Zhang Y, Castro AF, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med. https://doi.org/10.7326/0003-4819-150-9-200905050-00006 Google Scholar
- 17.Colquitt JL, Pickett K, Loveman E, Frampton GK (2014) Surgery for weight loss in adults. Cochrane Database Syst Rev 8:CD003641Google Scholar
- 18.Stevens LA, Schmid CH, Zhang YL, Coresh J, Manzi J, Landis R, Bakoush O, Contreras G, Genuth S, Klintmalm GB, Poggio E, Rossing P, Rule AD, Weir MR, Kusek J, Greene T, Levey AS (2010) Development and validation of GFR-estimating equations using diabetes, transplant and weight. Nephrol Dial Transplant. https://doi.org/10.1093/ndt/gfp510 Google Scholar
- 19.Schiavon CA, Bersch-Ferreira AC, Santucci EV, Oliveira JD, Torreglosa CR, Bueno PT, Frayha JC, Santos RN, Damiani LP, Noujaim PM, Halpern H, Monteiro FLJ, Cohen RV, Uchoa CH, De Souza MG, Amodeo C, Bortolotto L, Ikeoka D, Drager LF, Cavalcanti AB, Berwanger O (2018) Effects of bariatric surgery in obese patients with hypertension the GATEWAY randomized trial (gastric bypass to treat obese patients with steady hypertension). Circulation. https://doi.org/10.1161/CIRCULATIONAHA.117.032130 Google Scholar