Department of Surgery, University of California, Davis, 2221 Stockton Boulevard, Cypress Building, Sacramento, CA 95817, USA.
Obes Surg. 2012 Jul;22(7):1055-9. doi: 10.1007/s11695-012-0617-0.
Studies of the impact of Roux-en-Y gastric bypass (RYGB) on renal function have shown mixed results. We constructed this prospective repeated-measures controlled study to characterize this response and identify the best method of gauging renal function in this setting.
Clinical data, serum creatinine (SC), and 24-h urine were collected 1 week before and 6 months following RYGB. Glomerular filtration rate (GFR) was calculated utilizing the Modification of Diet in Renal Disease formula. Creatinine clearance (CCL) was measured as a 24-h collection (24 CCL) and calculated by the Cockcroft-Gault (CG) formula.
The study population of 37 patients (81% women) had a mean age of 47 ± 11 years, had mean BMI of 47.6 ± 6.3 kg/m(2), and achieved a mean % excess weight loss (EWL) of 60.9 ± 17.1%. SC decreased from 0.83 ± 0.21 mg/dl to 0.72 ± 0.16 mg/dl (p < 0.001) and mean GFR improved from 91.6 ± 29.7 ml/min/1.73 m(2) to 104.9 ± 23.5 ml/min/1.73 m(2) (p < 0.01). Preoperatively, CG significantly overestimated CCL when compared with 24 CCL (197.1 ± 88.2 ml/min vs. 136.5 ± 53.0 ml/min, p < 0.001). In all patients, improvement in 24 CCL correlated with EWL (r = 0.32) and %EWL (r = 0.16), and significantly correlated with decrease in BMI (r = 0.51, p < 0.005). In hypertensive patients, improvement in 24 CCL significantly correlated with EWL (r = 0.43, p < 0.05), %EWL (r = 0.40, p < 0.05), and decrease in BMI (r = 0.60, p < 0.001) and was negatively correlated with age (r = -0.45, p < 0.05).
This study demonstrates that renal function improves following RYGB and is best identified by change in GFR. Improvement in 24 CCL is correlated with the EWL success of the patient, especially hypertensive patients.
罗伊-耶格胃旁路术（RYGB）对肾功能影响的研究结果不一。我们进行了这项前瞻性重复测量对照研究，以描述这种反应，并确定在此环境下评估肾功能的最佳方法。
收集 RYGB 术前 1 周和术后 6 个月的临床数据、血清肌酐（SC）和 24 小时尿液。利用肾脏病饮食改良公式计算肾小球滤过率（GFR）。肌酐清除率（CCL）通过 24 小时收集（24 CCL）和 Cockcroft-Gault（CG）公式计算。
37 例患者（81%为女性）的研究人群平均年龄为 47±11 岁，平均 BMI 为 47.6±6.3kg/m²，平均超重百分比（EWL）为 60.9±17.1%。SC 从 0.83±0.21mg/dl 降至 0.72±0.16mg/dl（p<0.001），平均 GFR 从 91.6±29.7ml/min/1.73m²提高至 104.9±23.5ml/min/1.73m²（p<0.01）。与 24 CCL 相比，CG 术前显著高估 CCL（197.1±88.2ml/min 比 136.5±53.0ml/min，p<0.001）。在所有患者中，24 CCL 的改善与 EWL（r=0.32）和 EWL%（r=0.16）相关，与 BMI 下降显著相关（r=0.51，p<0.005）。在高血压患者中，24 CCL 的改善与 EWL（r=0.43，p<0.05）、EWL%（r=0.40，p<0.05）和 BMI 下降（r=0.60，p<0.001）显著相关，与年龄呈负相关（r=-0.45，p<0.05）。
本研究表明，RYGB 后肾功能改善，GFR 变化最能识别。24 CCL 的改善与患者 EWL 的成功相关，尤其是高血压患者。
