Department of Medicine, Indiana University School of Medicine, Indianapolis Indiana;
Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.
J Am Soc Nephrol. 2018 Apr;29(4):1289-1300. doi: 10.1681/ASN.2017060707. Epub 2018 Jan 15.
Obesity is linked to the development and progression of CKD, but whether bariatric surgery protects against CKD is poorly understood. We, therefore, examined whether bariatric surgery influences CKD risk. The study included 2144 adults who underwent bariatric surgery from March of 2006 to April of 2009 and participated in the Longitudinal Assessment of Bariatric Surgery-2 Study cohort. The primary outcome was CKD risk categories as assessed by the Kidney Disease Improving Global Outcomes (KDIGO) consortium criteria using a combination of eGFR and albuminuria. Patients were 79% women and 87% white, with a median age of 46 years old. Improvements were observed in CKD risk at 1 and 7 years after surgery in patients with moderate baseline CKD risk (63% and 53%, respectively), high baseline risk (78% and 56%, respectively), and very high baseline risk (59% and 23%, respectively). The proportion of patients whose CKD risk worsened was ≤10%; five patients developed ESRD. Sensitivity analyses using year 1 as baseline to minimize the effect of weight loss on serum creatinine and differing eGFR equations offered qualitatively similar results. Treatment with bariatric surgery associated with an improvement in CKD risk categories in a large proportion of patients for up to 7 years, especially in those with moderate and high baseline risk. These findings support consideration of CKD risk in evaluation for bariatric surgery and further study of bariatric surgery as a treatment for high-risk obese patients with CKD.
肥胖与 CKD 的发生和进展有关,但减重手术是否能预防 CKD 仍知之甚少。因此,我们研究了减重手术是否会影响 CKD 的风险。该研究纳入了 2144 名于 2006 年 3 月至 2009 年 4 月期间接受减重手术且参与了纵向评估减重手术 2 研究队列的成年人。主要结局是根据肾脏病改善全球结局(KDIGO)协作组标准,采用 eGFR 和白蛋白尿的组合评估的 CKD 风险类别。患者中 79%为女性,87%为白人,中位年龄为 46 岁。在中危基线 CKD 风险(分别为 63%和 53%)、高危基线风险(分别为 78%和 56%)和极高危基线风险(分别为 59%和 23%)患者中,术后 1 年和 7 年观察到 CKD 风险改善。风险恶化的患者比例≤10%;5 名患者发展为 ESRD。使用基线为 1 年的敏感性分析,以尽量减少体重减轻对血清肌酐的影响和不同 eGFR 方程提供了定性相似的结果。在长达 7 年的时间里,减重手术治疗与 CKD 风险类别的改善相关,特别是在中危和高危基线风险的患者中。这些发现支持在评估减重手术时考虑 CKD 风险,并进一步研究减重手术作为治疗 CKD 高危肥胖患者的方法。