Advertisement

Obesity Surgery

, Volume 29, Issue 1, pp 197–206 | Cite as

Analyzing the Impact of Bariatric Surgery in Kidney Function: a 2-Year Observational Study

  • Daniela S. C. MagalhãesEmail author
  • Jorge M. P. Pedro
  • Pedro E. B. Souteiro
  • João Sérgio Neves
  • Sofia Castro-Oliveira
  • Rita Bettencourt-Silva
  • Maria Manuel Costa
  • Ana Varela
  • Joana Queirós
  • Paula Freitas
  • Davide Carvalho
Original Contributions
  • 121 Downloads

Abstract

Background

Obesity is an independent risk factor for chronic kidney disease (CKD). Our aims were: (1) to evaluate the impact of bariatric surgery (BS) on kidney function, (2) clarify the factors determining postoperative evolution of glomerular filtration rate (ΔGFR) and urinary albumin-to-creatinine ratio (ΔUACR), and (3) access the occurrence of oxalate-mediated renal complications.

Methods

We investigated a cohort of 1448 obese patients who underwent BS. Those with baseline-estimated GFR (eGFR0) < 30 mL/min or without information about the 2-year post-surgical eGFR (eGFR2) were excluded.

Results

A total of 725 patients were included. At baseline, 38(5.2%) had hyperfiltration with eGFR0 ≥ 125 mL/min/1.73m2 (G0), 492 (67.9%) had eGFR0 90–124 mL/min/1.73m2 (G1), 178 (24.6%) had eGFR0 60–89 mL/min/1.73m2 (G2), and 17 (2.3%) had eGFR0 < 60 mL/min/1.73m2 (G3). ΔGFR significantly increased in 96.6% (ΔGFR = 23.8 (IQR 15.9–29.8)) and 82.4% (ΔGFR = 18.6 (IQR 3.6–44.0)) of the subjects with G2 and G3 CKD, respectively (p < 0.001). The variables independently associated with ΔGFR were baseline body mass index (BMI) (positively), high blood pressure (HBP) (negatively), and fasting plasma glucose (FPG) (negatively), as well as FPG variation (positively). An overall prevalence of high UACR (≥ 30 mg/g−1) of 17.9% was found, with 81.5% of these subjects presenting A2(30–300 mg/g−1) and 18.5% A3(> 300 mg/g−1) UACR. UACR significantly decreased after BS (p < 0.001). Significant predictors of ΔUACR were BMI, systolic blood pressure, and HbA1c. Urinary excretion of calcium oxalate crystals was found in 77(11.1%) patients, with only 1 presenting oxalate-mediated renal complications.

Conclusions

ΔGFR seems to be influenced by the initial kidney function, as it decreases in subjects with hyperfiltration but tends to increase in those with kidney dysfunction. These results suggest that BS is associated with improvement of kidney outcomes, without a significant increase in renal complications.

Keywords

Albuminuria Bariatric surgery Glomerular filtration rate Renal function 

Abbreviations

DM

Diabetes mellitus

HBP

High blood pressure

CKD

Chronic kidney disease

UAE

Urinary albumin excretion

BS

Bariatric surgery

eGFR

Estimated glomerular filtration rate

RYGB

Roux-en-Y gastric bypass

eGFR0

Baseline-estimated glomerular filtration rate

eGFR2

2-Year post-surgery estimated glomerular filtration rate

BMI

Body mass index

WC

Waist circumference

HC

Hip circumference

SBP

Systolic blood pressure

DBP

Diastolic blood pressure

WBC

White blood cells count

CRP

C-reactive protein

FPG

Fasting plasma glucose

UACR

Urinary albumin-to-creatinine ratio

ID-MS

Isotope dilution mass spectrometry

CKD-EPI

Chronic kidney disease epidemiology collaboration formula

KDIGO

Kidney disease improving global outcomes

ΔGFR

Glomerular filtration rate variation

ΔUACR

Urinary albumin-to-creatinine ratio

HPF

High-power field

VIF

Variance inflation factor

AGB

Adjustable gastric band

VG

Vertical gastrectomy

EWL

Excess weight loss

HDL-C

High-density lipoprotein cholesterol

TG

Triglycerides

TC

Total cholesterol

LDL-C

Low-density lipoprotein cholesterol

Notes

Authors’ Contributions

All authors participated in the collection of data. DM interpreted the data and wrote the manuscript. All authors read and approved the final manuscript.

Funding

This research did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384(9945):766–8.CrossRefGoogle Scholar
  2. 2.
    Garvey WT, Mechanick J, Brett EM, et al. American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity. Endocr Pract. 2016;22(Suppl 3):1–203.CrossRefGoogle Scholar
  3. 3.
    Coupaye M, Flamant M, Sami O, et al. Determinants of evolution of glomerular filtration rate after bariatric surgery: a 1-year observational study. Obes Surg. 2017;27(1):126–33.CrossRefGoogle Scholar
  4. 4.
    Carlsson LM, Romeo S, Jacobson P, et al. The incidence of albuminuria after bariatric surgery and usual care in Swedish Obese Subjects (SOS): a prospective controlled intervention trial. Int J Obes. 2015;39(1):169–75.CrossRefGoogle Scholar
  5. 5.
    Hunley TE, Ma L, Kon V. Scope and mechanisms of obesity-related renal disease. Curr Opin Nephrol Hypertens. 2010;19(3):227–34.CrossRefGoogle Scholar
  6. 6.
    Holcomb CN, Goss L, Almehmi A, et al. Bariatric surgery is associated with renal function improvement. Surg Endosc. 2018;32(1):276–81.CrossRefGoogle Scholar
  7. 7.
    Chang AR, Chen Y, Still C, et al. Bariatric surgery is associated with improvement in kidney outcomes. Kidney Int. 2016;90(1):164–71.CrossRefGoogle Scholar
  8. 8.
    Agrawal V, Navaneethan S. Bariatric surgery for obesity-associated decline in kidney function: filling the knowledge gap? Kidney Int. 2016;90(1):28–30.CrossRefGoogle Scholar
  9. 9.
    Kim EY, Kim Y. Does bariatric surgery really prevent deterioration of renal function? Surg Obes Relat Dis. 2016;12(4):856–61.CrossRefGoogle Scholar
  10. 10.
    Chagnac A, Weinstein T, Korzets A, et al. Glomerular hemodynamics in severe obesity. Am J Physiol Ren Physiol. 2000;278(5):F817–22.CrossRefGoogle Scholar
  11. 11.
    Friedman AN, Wahed A, Wang J, et al. Effect of bariatric surgery on CKD risk. J Am Soc Nephrol. 2018:15.Google Scholar
  12. 12.
    Bolignano D, Zoccali C. Effects of weight loss on renal function in obese CKD patients: a systematic review. Nephrol Dial Transplant. 2013;28(Suppl 4):iv82–98.CrossRefGoogle Scholar
  13. 13.
    Marathe PH, Gao HX, Close KL. American Diabetes Association standards of medical care in diabetes 2017. J Diabetes. 2017;9(4):320–4.CrossRefGoogle Scholar
  14. 14.
    National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002;106(25):3143–421.CrossRefGoogle Scholar
  15. 15.
    Eknoyad G, Lameire N. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Inter Suppl. 2013;3:1–150.Google Scholar
  16. 16.
    Hou CC, Shyu R, Lee WJ, et al. Improved renal function 12 months after bariatric surgery. Surg Obes Relat Dis. 2013;9(2):202–6.CrossRefGoogle Scholar
  17. 17.
    Rosenstock JL, Pommier M, Stoffels G, et al. Prevalence of proteinuria and albuminuria in an obese population and associated risk factors. Front Med (Lausanne). 2018;5:122.CrossRefGoogle Scholar
  18. 18.
    Reid TJ, Saeed S, McCoy S, et al. The effect of bariatric surgery on renal function. Surg Obes Relat Dis. 2014;10(5):808–13.CrossRefGoogle Scholar
  19. 19.
    Bhatti UH, Duffy AJ, Roberts KE, et al. Nephrolithiasis after bariatric surgery: a review of pathophysiologic mechanisms and procedural risk. Int J Surg. 2016;36(Pt D):618–23.CrossRefGoogle Scholar
  20. 20.
    Gonzalez RD, Canales BK. Kidney stone risk following modern bariatric surgery. Curr Urol Rep. 2014;15(5):401.CrossRefGoogle Scholar
  21. 21.
    Getty JL, Hamdallah I, Shamseddeen HN, et al. Changes in renal function following Roux-en-Y gastric bypass: a prospective study. Obes Surg. 2012;22(7):1055–9.CrossRefGoogle Scholar
  22. 22.
    Friedman AN, Moe S, Fadel WF, et al. Predicting the glomerular filtration rate in bariatric surgery patients. Am J Nephrol. 2014;39(1):8–15.CrossRefGoogle Scholar
  23. 23.
    Lovell A, Game P, Wittert G, et al. Estimating renal function in morbidly. Obes Surg. 2013;23(9):1427–30.CrossRefGoogle Scholar
  24. 24.
    Fried M, Yumuk V, Oppert JM, et al. Interdisciplinary European guidelines on metabolic and bariatric surgery. Obes Facts. 2013;6(5):449–68.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Daniela S. C. Magalhães
    • 1
    • 2
    • 3
    Email author
  • Jorge M. P. Pedro
    • 1
    • 2
    • 3
  • Pedro E. B. Souteiro
    • 1
    • 2
    • 3
  • João Sérgio Neves
    • 1
    • 2
    • 3
  • Sofia Castro-Oliveira
    • 1
    • 2
    • 3
  • Rita Bettencourt-Silva
    • 1
    • 2
    • 3
  • Maria Manuel Costa
    • 1
    • 2
    • 3
  • Ana Varela
    • 1
    • 2
    • 3
    • 4
  • Joana Queirós
    • 1
  • Paula Freitas
    • 1
    • 2
    • 3
    • 4
  • Davide Carvalho
    • 1
    • 2
    • 3
  1. 1.Endocrinology, Diabetes and Metabolism DepartmentCentro Hospitalar São JoãoPortoPortugal
  2. 2.Faculty of MedicineUniversity of PortoPortoPortugal
  3. 3.Instituto de Investigação e Inovação em SaúdeUniversity of PortoPortoPortugal
  4. 4.Multidisciplinary Group for Surgical Management of ObesityCentro Hospitalar de São JoãoPortoPortugal

Personalised recommendations