Section of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, 1922 7th Ave South, KB 217, Birmingham, AL, 35294, USA.
Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Surg Endosc. 2018 Jan;32(1):276-281. doi: 10.1007/s00464-017-5674-y. Epub 2017 Jun 29.
Weight loss after bariatric surgery improves both blood pressure and glycemic control following surgery. The effect of bariatric surgery on renal function is not well characterized. In this study, we sought to quantify the change in renal function over time following surgery.
We retrospectively reviewed all patients who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) between 2012 and 2014 at our institution. The glomerular filtration rate (GFR, mL/min) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Body mass index (BMI, kg/m) and percent weight loss (%WL) were calculated following the surgery.
A total of 149 patients who underwent bariatric surgery were included in this study: LRYGB (n = 86 and LSG (n = 63). In LRYGB group, baseline BMI (kg/m, ±SD) and GFR (mL/min, ±SD) were 48.5 ± 6.8 and 94.7 ± 23.8, respectively. In comparison, BMI and GFR were 49.1 ± 11.9 kg/m and 93.1 ± 28.0 mL/min in the LSG group, respectively. Over the follow-up period (19.89 ± 10.93 months), the patients who underwent LRGYB lost a larger percentage of weight as compared to those in the LSG group (29.9 ± 11.7% vs 22.3 ± 10.7%; p = <0.0001). Overall, GFR improved in both LRYGB (101.0 ± 25.8 mL/min) and LSG groups (97.9 ± 25.8 mL/min) and was not significantly different between the two groups. Of patients with a GFR < 90 mL/min prior to weight loss surgery (n = 62), 42% had improvement of their GFR to > 90 mL/min postoperatively (p < 0.001). There was no relationship between weight loss percentage and GFR improvement (p = 0.8703).
Bariatric surgery was associated with improvement in postoperative renal function at almost two years following surgery but was not different for LRYGB versus LSG. The gain in GFR was independent of percentage of weight lost suggesting an alternate mechanism in the improvement of renal function other than weight loss alone.
减重手术后体重减轻可改善术后血压和血糖控制。减重手术对肾功能的影响尚不清楚。本研究旨在定量分析术后肾功能随时间的变化。
我们回顾性分析了 2012 年至 2014 年期间在我院行腹腔镜 Roux-en-Y 胃旁路术（LRYGB）或腹腔镜袖状胃切除术（LSG）的所有患者。采用慢性肾脏病流行病学合作研究（CKD-EPI）方程计算肾小球滤过率（GFR，ml/min）。术后计算体重指数（BMI，kg/m）和体重减轻百分比（%WL）。
本研究共纳入 149 例接受减重手术的患者：LRYGB（n=86）和 LSG（n=63）。LRYGB 组患者术前 BMI（kg/m，±SD）和 GFR（ml/min，±SD）分别为 48.5±6.8 和 94.7±23.8，LSG 组患者术前 BMI 和 GFR 分别为 49.1±11.9 kg/m 和 93.1±28.0 ml/min。在随访期间（19.89±10.93 个月），与 LSG 组相比，LRGYB 组患者体重减轻百分比更大（29.9±11.7% vs 22.3±10.7%；p<0.0001）。总体而言，LRYGB（101.0±25.8 ml/min）和 LSG 组（97.9±25.8 ml/min）的 GFR 均有所改善，两组间无显著差异。在术前 GFR<90 ml/min 的患者（n=62）中，42%的患者术后 GFR 改善至>90 ml/min（p<0.001）。体重减轻百分比与 GFR 改善无相关性（p=0.8703）。
减重手术后近 2 年，患者的肾功能得到改善，但 LRYGB 与 LSG 之间无差异。GFR 的增加与体重减轻百分比无关，提示除体重减轻外，肾功能改善可能存在其他机制。
