Nephrology Department, "Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania.
Endocrinology Clinic, "St. Spiridon" Hospital, Iasi, Romania.
Obes Surg. 2018 Dec;28(12):3815-3833. doi: 10.1007/s11695-018-3416-4.
BACKGROUND/OBJECTIVE: Although promising, data regarding the renal impact and safety of bariatric surgery (BS) are insufficient. We aimed at investigating the benefits and harms of BS for weight loss on kidney function.
A systematic review and meta-analysis of observational studies reporting data about the impact of BS (any techniques) on serum/plasma creatinine, creatinine clearance, glomerular filtration rate (GFR), proteinuria, nephrolithiasis, and need for renal replacement therapy (RRT)) was performed. Obese adults (non-chronic kidney disease (CKD), CKD or transplanted patients) that underwent BS for weight loss were included. After searching MEDLINE (inception to August 2017), the Cochrane Library (Issue 10-12, October 2017), and the websiteclinicaltrials.gov (August 2017), data were extracted and summarized using a random-effects model.
The final analysis included 23 cohort studies, comprising 3015 participants. Compared with renal function before treatment, BS significantly decreased serum creatinine level (mean difference (MD), - 0.08 mg dl; 95% confidence interval (CI), - 0.10 to - 0.06); p < 0.001) and proteinuria (MD, - 0.04 g 24 h; 95% CI, - 0.06 to - 0.02; p < 0.001) in the overall group. GFR significantly improved 6 months or more after BS both in the hyperfiltration and CKD subgroups. Renal function also tended to improve in renal transplant patients. Data on nephrolithiasis and the need for RRT were scarce or not reported.
BS apparently has positive effects on kidney function and tends to normalize GFR across different categories of renal impairment (hyperfiltration and CKD patients).
背景/目的：尽管有希望，但有关减肥手术（BS）对肾脏影响和安全性的数据还不够充分。我们旨在研究 BS 对肾功能减肥的益处和危害。
对报告有关 BS（任何技术）对血清/血浆肌酐、肌酐清除率、肾小球滤过率（GFR）、蛋白尿、肾结石和肾脏替代治疗（RRT）需求影响的观察性研究进行了系统评价和荟萃分析。纳入接受 BS 减肥的肥胖成年人（非慢性肾脏病（CKD）、CKD 或移植患者）。在搜索 MEDLINE（从成立到 2017 年 8 月）、Cochrane 图书馆（第 10-12 期，2017 年 10 月）和 clinicaltrials.gov 网站（2017 年 8 月）后，使用随机效应模型提取和总结数据。
最终分析包括 23 项队列研究，共 3015 名参与者。与治疗前肾功能相比，BS 显著降低血清肌酐水平（平均差异（MD），-0.08mg/dl；95%置信区间（CI），-0.10 至-0.06；p<0.001）和蛋白尿（MD，-0.04g/24h；95%CI，-0.06 至-0.02；p<0.001）。BS 后 6 个月或更长时间，在高滤过和 CKD 亚组中，GFR 显著改善。肾功能也倾向于在肾移植患者中改善。关于肾结石和 RRT 需求的数据很少或未报告。
BS 显然对肾功能有积极影响，并且倾向于使不同类型的肾功能损害（高滤过和 CKD 患者）的 GFR 正常化。
