Wakamatsu Kotaro, Seki Yosuke, Kasama Kazunori, Uno Kohei, Hashimoto Kenkichi, Seto Yasuyuki, Kurokawa Yoshimochi
Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan.
Department of Gastrointestinal Surgery, University of Tokyo, Bunkyo, Tokyo, Japan.
Obes Surg. 2018 Feb;28(2):489-496. doi: 10.1007/s11695-017-2863-7.
The prevalence of chronic kidney disease (CKD) among Japanese morbidly obese patients undergoing bariatric surgery and the impact of bariatric surgery on their renal function has not previously been investigated.
The aims were to assess the prevalence of CKD patients who underwent bariatric surgery in our institution and to elucidate the impact of bariatric surgery on their kidney function as measured by the estimated glomerular filtration rate by Cystatin-C (eGFRcys).
The setting of the study was in a single private hospital.
Two hundred fifty-four consecutive Japanese patients who underwent bariatric surgery were retrospectively analyzed to elucidate the prevalence of CKD. The eGFRcys was calculated to assess the change in the kidney function for 1 year after surgery.
The preoperative prevalence of CKD was as follows: G1, 45.3%; G2, 47.2%; G3, 6.5%; and G4, 0.9%. The eGFRcys values before and after surgery were compared; the G1 and G2 patients showed significantly improved eGFRcys values after surgery (G1 101 [94-108] vs 114 [103-127]; G2 79 [74-84] vs 97 [87-104] ml/min/1.73 m; p < 0.01) with significant weight loss (G1 38.1 ± 6.2 vs 26.5 ± 3.4; G2 38.5 ± 6.9 vs 26.7 ± 3.6 kg/m; p < 0.01). Although the renal function of G3 patients was not improved after surgery (44 [42-47] vs 45 [43-63] ml/min/1.73 m; p = 0.08), successful weight loss was achieved (36.1 ± 6.3 vs 26.6 ± 3.6 kg/m; p < 0.01). In multivariate analysis, postoperative eGFRcys correlated negatively with proteinuria (p < 0.01), age (p < 0.01), and body mass index (p < 0.01) and positively with persistence of antihypertensive drugs.
Bariatric surgery resulted in the significant improvement in the eGFRcys values of Japanese patients with morbid obesity, particularly those with pre-CKD (eGFRcys ≥ 60 ml/min/1.73 m), while the eGFRcys values of CKD patients (< 60 ml/min/1.73 m) were not ameliorated by surgery.
此前尚未对接受减肥手术的日本病态肥胖患者中慢性肾脏病（CKD）的患病率以及减肥手术对其肾功能的影响进行过研究。
本研究旨在评估在我们机构接受减肥手术的CKD患者的患病率，并阐明减肥手术对其肾功能的影响，采用胱抑素C估算的肾小球滤过率（eGFRcys）进行测量。
本研究在一家私立医院进行。
对254例连续接受减肥手术的日本患者进行回顾性分析，以阐明CKD的患病率。计算eGFRcys以评估术后1年肾功能的变化。
术前CKD的患病率如下：G1期，45.3%；G2期，47.2%；G3期，6.5%；G4期，0.9%。比较手术前后的eGFRcys值；G1和G2期患者术后eGFRcys值显著改善（G1期：101[94 - 108]对比114[103 - 127]；G2期：79[74 - 84]对比97[87 - 104]ml/min/1.73m²；p < 0.01），且体重显著减轻（G1期：38.1±6.2对比26.5±3.4；G2期：38.5±6.9对比26.7±3.6kg/m²；p < 0.01）。虽然G3期患者术后肾功能未改善（44[42 - 47]对比45[43 - 63]ml/min/1.73m²；p = 0.08），但实现了成功减重（36.1±6.3对比26.6±3.6kg/m²；p < 0.01）。在多因素分析中，术后eGFRcys与蛋白尿（p < 0.01）、年龄（p < 0.01）和体重指数（p < 0.01）呈负相关，与降压药物的持续使用呈正相关。
减肥手术使日本病态肥胖患者，尤其是CKD前期（eGFRcys≥60ml/min/1.73m²）患者的eGFRcys值显著改善，而CKD患者（<60ml/min/1.73m²）的eGFRcys值未因手术而改善。
