Specialist Weight Management Services, Heart of England Foundation NHS Trust, Birmingham, UK.
Obes Surg. 2013 May;23(5):634-7. doi: 10.1007/s11695-012-0851-5.
The prevalences of obesity and chronic kidney disease (CKD) have increased simultaneously. Should a pathophysiological relationship exist between the two conditions, bariatric surgery and associated weight loss could be an important intervention in extremely obese individuals to slow the progression of CKD.
We conducted a retrospective analysis of 25 patients who had undergone biliopancreatic diversion (BPD) surgery for extreme obesity (body mass index >40 kg/m(2)), with mean follow-up of 4 years. We assessed pre- and post-surgery renal function, body weight and blood pressure (BP) obtained from electronic hospital and primary care records.
There was a significant reduction in mean body weight at 4 years by 50.3 kg (SD = 20.65). The creatinine and estimated glomerular filtration rate (eGFR) also improved significantly: serum creatinine reduced by 16.2 μmol/l (SD = 19.57) while the eGFR improved by 10.6 ml/min/m(2) (SD = 15.45). The greatest improvement in eGFR was in the group (n = 7) with eGFR ≤60 ml/min/m(2). A subset of patients (n = 11) had evaluable BP readings and had a reduction in BP of 17/10 mmHg (SD = 33/12).
This retrospective study demonstrates a clinically significant improvement in renal function following BPD. Several mechanisms including weight loss could account for the positive impact on renal function. The physiology underlying this improvement requires further study.
肥胖症和慢性肾脏病（CKD）的患病率同时增加。如果这两种情况存在病理生理学关系，那么减肥手术和相关的体重减轻可能是极度肥胖个体减缓 CKD 进展的重要干预措施。
我们对 25 例因极度肥胖（体重指数>40kg/m2）而行胆胰分流术（BPD）的患者进行了回顾性分析，平均随访 4 年。我们评估了电子病历和初级保健记录中获得的手术前后肾功能、体重和血压（BP）。
4 年后平均体重显著减轻 50.3kg（SD=20.65）。血清肌酐和估算肾小球滤过率（eGFR）也显著改善：血清肌酐降低 16.2μmol/L（SD=19.57），而 eGFR 提高 10.6ml/min/m2（SD=15.45）。eGFR≤60ml/min/m2组（n=7）的 eGFR 改善最大。有一部分患者（n=11）有可评估的 BP 读数，BP 降低 17/10mmHg（SD=33/12）。
这项回顾性研究表明，BPD 后肾功能有明显改善。包括体重减轻在内的多种机制可能导致对肾功能的积极影响。这种改善的生理学基础需要进一步研究。
