Severe Chronic Kidney Disease Is Associated with a Lower Efficiency of Bariatric Surgery
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Obesity is a risk factor for chronic kidney disease (CKD) and a relative contraindication for renal transplantation. Bariatric surgery (BS) is an option to address this issue but we hypothesize that severe CKD is associated with a loss of efficacy of BS which could justify recommending it at an earlier stage of the CKD.
A retrospective study (n = 101 patients) to test primarily for differences in weight loss at 6 and 12 months according to estimated glomerular filtration rate categories (eGFR < 30 including patients on dialysis, 30–60, 60–90, and ≥ 90 ml/min/1.73 m2) was performed with multivariate analysis adjusted for sex, age, BMI, surgical procedure, and diabetes. We used a second method to confirm our hypothesis comparing weight loss in patients with stage 4–5 CKD (eGFR < 30 ml/min/1.73 m2, n = 17), and matched controls with eGFR ≥ 90 ml/min/1.73 m2.
In the first comparison, the multivariate analysis showed a significant positive association between eGFR and weight loss. However, after exclusion of the subgroup of patients with eGFR < 30 ml/min/1.73 m2, the difference between groups was no more significant. In addition, percent total weight loss (%TWL) was significantly lower in patients with severe CKD compared to controls: − 15% vs − 23% at 6 months (p < 0.01); − 17% vs − 27% at 12 months (p < 0.01). The percent excess weight loss at 1 year reached 47% in patients with stage 4–5 CKD and 68% in controls subjects (p < 0.01). Surgery was a success at 12 months (weight loss > 50% of excess weight) in 38% of advanced CKD and 88% of controls (p < 0.01).
The efficacy of BS was reduced in patients with advanced CKD. These results support early BS in patients with early-to-moderate CKD.
KeywordsChronic kidney disease stages Weight loss Benefit/risk ratio Roux-en-Y gastric bypass Sleeve gastrectomy
Institut National de la Santé et de la Recherche Médicale
Hôpitaux Universitaires Paris-Nord Val de Seine
Assistance Publique-Hôpitaux de Paris
Compliance with Ethical Standards
Conflict of Interest
Dr. Hansel reports grants from Amgen, Sanofi, personal fees from Sanofi, AMGEN, Novo Nordisk, Smartsante, Jalma, and MXS, outside the submitted work;
Dr. Arapis has nothing to disclose.
Dr. Kadouch has nothing to disclose.
Dr. Ledoux has nothing to disclose.
Dr. Coupaye has nothing to disclose.
Dr. Msika has nothing to disclose.
Dr. Vrtovsnik has nothing to disclose.
Dr. Marre reports grants and personal fees from Novo Nordisk, personal fees from Servier, personal fees from Merck, personal fees from Lilly, personal fees from Sanofi, and personal fees from Abbott, outside the submitted work;
Dr. Boutten has nothing to disclose.
Dr. Cherifi has nothing to disclose.
Dr. Courie has nothing to disclose.
Ms. Beslay has nothing to disclose.
Dr. Coupaye has nothing to disclose.
Dr. Cambos has nothing to disclose.
Dr. Roussel reports grants and personal fees from Sanofi, personal fees from Astra Zeneca, personal fees from Eli Lilly, personal fees from MSD, personal fees from Novo Nordisk, and personal fees from Janssen, outside the submitted work
- 5.Yun HR, Kim H, Park JT, et al. Obesity, metabolic abnormality, and progression of CKD. Am J Kidney Dis. 2018;72(3):400–10.Google Scholar
- 8.Association TR. The renal association assessment of the potential kidney transplant recipient. 2011.Google Scholar
- 14.Shulman A, Peltonen M, Sjostrom CD, et al. Incidence of end-stage renal disease following bariatric surgery in the Swedish Obese Subjects Study. Int J Obes. 2018;42(5):964–73.Google Scholar
- 18.Lambert K, Beer J, Dumont R, et al. Weight management strategies for those with chronic kidney disease - a consensus report from the Asia Pacific Society of Nephrology and Australia and New Zealand Society of Nephrology 2016 renal dietitians meeting. Nephrology (Carlton) 2018;23(10):912–20Google Scholar
- 25.Ravussin E, Gautier JF. Determinants and control of energy expenditure. Ann Endocrinol (Paris). 2002;63(2 Pt 1):96–105. Determinants et controle des depenses energetiquesGoogle Scholar
- 26.Johansen KL, Lee C. Body composition in chronic kidney disease. Curr Opin Nephrol Hypertens. 2015;24(3):268–75.Google Scholar