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Kidney Int. 2016 Jul;90(1):164-71. doi: 10.1016/j.kint.2016.02.039. Epub 2016 May 12.

Bariatric surgery is associated with improvement in kidney outcomes.

Author information

1
Division of Nephrology, Geisinger Health System, Danville, Pennsylvania, USA. Electronic address: achang@geisinger.edu.
2
Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA.
3
Obesity Institute, Geisinger Health System, Danville, Pennsylvania, USA.
4
Biomedical & Translational Informatics, Geisinger Health System, Danville, Pennsylvania, USA.
5
Division of Nephrology, Loyola University Medical Center, Chicago, Illinois, USA.
6
Division of Nephrology, Geisinger Health System, Danville, Pennsylvania, USA.
7
Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA; Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
8
Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA; Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Abstract

Severe obesity is associated with increased risk of kidney disease. Whether bariatric surgery reduces the risk of adverse kidney outcomes is uncertain. To resolve this we compared the risk of estimated glomerular filtration rate (eGFR) decline of ≥30% and doubling of serum creatinine or end-stage renal disease (ESRD) in 985 patients who underwent bariatric surgery with 985 patients who did not undergo such surgery. Patients were matched on demographics, baseline body mass index, eGFR, comorbidities, and previous nutrition clinic use. Mean age was 45 years, 97% were white, 80% were female, and 33% had baseline eGFR <90 ml/min per 1.73 m(2). Mean 1-year weight loss was 40.4 kg in the surgery group compared with 1.4 kg in the matched cohort. Over a median follow-up of 4.4 years, 85 surgery patients had an eGFR decline of ≥30% (22 had doubling of serum creatinine/ESRD). Over a median follow-up of 3.8 years, 177 patients in the matched cohort had an eGFR decline of ≥30% (50 had doubling of serum creatinine/ESRD). In adjusted analysis, bariatric surgery patients had a significant 58% lower risk for an eGFR decline of ≥30% (hazard ratio 0.42, 95% confidence interval 0.32-0.55) and 57% lower risk of doubling of serum creatinine or ESRD (hazard ratio 0.43, 95% confidence interval: 0.26-0.71) compared with the matched cohort. Results were generally consistent among subgroups of patients with and without eGFR <90 ml/min per 1.73 m(2), hypertension, and diabetes. Thus, bariatric surgery may be an option to prevent kidney function decline in severely obese individuals.

KEYWORDS:

GFR; Roux-en-Y surgery; bariatric surgery; gastric bypass; glomerular filtration rate; kidney function; morbid obesity; weight loss

PMID:
27181999
PMCID:
PMC4912457
DOI:
10.1016/j.kint.2016.02.039
[Indexed for MEDLINE]
Free PMC Article

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