Ngoh Clara Lee Ying, So Jimmy Bok Yan, Tiong Ho Yee, Shabbir Asim, Teo Boon Wee
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Department of General Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Surg Obes Relat Dis. 2016 Mar-Apr;12(3):600-605. doi: 10.1016/j.soard.2015.07.003. Epub 2015 Jul 9.
Current literature reports improvement in kidney function in obese patients after bariatric surgery in non-Asian centers. It is unclear how kidney function is affected by postoperative body composition changes in obese Asian patients.
To evaluate kidney function and its relationship to body composition in a multiethnic Asian population after bariatric surgery.
This study was performed in a university hospital.
Data of 68 obese patients who were followed for 1 year after surgery were retrieved from our university hospital clinical care database. Body composition was obtained by bioimpedance analysis. Kidney function was calculated as glomerular filtration rate (GFR) using the following formulas: (1) Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) (estimated GFR [eGFR], mL/min/1.73 m(2)); (2) absolute GFR (aGFR, mL/min); and (3) lean weight-adjusted Cockcroft-Gault creatinine clearance (CG-LBW, mL/min). Patients were further examined by 2 subgroups: eGFR<90 and>90 mL/min/1.73 m(2).
One year after surgery, body mass index (BMI) declined from 41.9±5.7 to 29.6±4.2 kg/m(2) (P<.001), body surface area (BSA) decreased from 2.15±0.23 to 1.86±0.18 m(2) (P<.001), and fat mass (FM) reduced from 45.8±9.4 to 25.6±10.5 kg (P<.001). There were significant differences in percentage excess weight loss (%EWL) among Chinese, Malays, Indians, and other ethnicities. Similar results were found with percentage fat mass loss (%FML). Changes in aGFR were associated with reductions in FM (P = .010), BSA (P = .049), and %EWL (P<.001). In the eGFR>90 subgroup, eGFR decreased from 143±22 to 122±19 mL/min/1.73 m(2). Conversely, in the eGFR<90 subgroup, eGFR had a trend of improvement from 69 to 79 mL/min/1.73 m(2).
Changes in eGFR after bariatric surgery in the obese Asian patient are strongly associated with reduction in FM, BSA, and %EWL. More work is required to investigate if certain ethnicities have better postoperative renal profiles.
目前的文献报道了非亚洲地区肥胖患者在接受减肥手术后肾功能有所改善。尚不清楚肥胖亚洲患者术后身体成分变化如何影响肾功能。
评估减肥手术后多民族亚洲人群的肾功能及其与身体成分的关系。
本研究在一家大学医院进行。
从我们大学医院的临床护理数据库中检索了68例肥胖患者术后1年的随访数据。通过生物电阻抗分析获得身体成分。使用以下公式将肾功能计算为肾小球滤过率（GFR）：（1）慢性肾脏病流行病学协作组（CKD-EPI）（估算肾小球滤过率[eGFR]，mL/min/1.73 m²）；（2）绝对肾小球滤过率（aGFR，mL/min）；以及（3）瘦体重校正的Cockcroft-Gault肌酐清除率（CG-LBW，mL/min）。患者进一步分为两个亚组：eGFR<90和>90 mL/min/1.73 m²。
术后1年，体重指数（BMI）从41.9±5.7降至29.6±4.2 kg/m²（P<.001），体表面积（BSA）从2.15±0.23降至1.86±0.18 m²（P<.001），脂肪量（FM）从45.8±9.4降至25.6±10.5 kg（P<.001）。华裔、马来裔、印度裔和其他种族在超重减轻百分比（%EWL）方面存在显著差异。脂肪量减少百分比（%FML）也有类似结果。aGFR的变化与FM的减少（P = .010）、BSA的减少（P = .049）和%EWL的减少（P<.001）相关。在eGFR>90亚组中，eGFR从143±22降至122±19 mL/min/1.73 m²。相反，在eGFR<90亚组中，eGFR有从69改善至79 mL/min/1.73 m²的趋势。
肥胖亚洲患者减肥手术后eGFR的变化与FM、BSA和%EWL的减少密切相关。需要更多研究来调查某些种族是否具有更好的术后肾脏状况。
