Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL.
ScienceRight Research Consulting, London, Ontario, Canada.
Ann Surg. 2019 Sep;270(3):511-518. doi: 10.1097/SLA.0000000000003456.
According to the Chronic Kidney Disease Prognosis Consortium (CKD-PC), 1 in 4 patients age ≥ 65 in North America has some form of chronic kidney disease (CKD), while 3 in 100 will progress to kidney failure. The aim of this study was to evaluate whether bariatric surgery alters the progression of CKD to kidney failure in patients who are severely obese.
We conducted a retrospective review of all patients who underwent bariatric surgery at our institution over the last 16 years. Kidney function and injury were assessed using the average estimated glomerular filtration rate and urinary albumin-to-creatinine ratio (uACR) over 3 months preoperatively and postoperative at 12-month follow-up. The risk of progression from CKD to kidney failure was assessed using the Chronic Kidney Disease Prognosis Consortium (CKD-PC) equation.
Out of 2924 patients reviewed over this period of time, 69 (2.4%) had the recorded data necessary to assess kidney injury and the risk of disease progression to kidney failure. Patients within moderate and severe stages of CKD-related albuminuria improved the most at 12-month follow-up (by 48% and 79%; P = 0.0001 and P = 0.025, respectively). This translated to a relative risk reduction for progression to kidney failure in CKD ≥ stage 3 patients of 70% at 2 years and 60% at 5 years (both P = 0.001).
Bariatric surgery seems to improve kidney injury, especially among patients with the most severe stages of CKD. Marked 2- and 5-year risk reduction in the progression from CKD to kidney failure was observed.
根据慢性肾脏病预后联盟（CKD-PC）的数据，在北美，年龄≥65 岁的患者中有 1/4 患有某种形式的慢性肾脏病（CKD），而每 100 人中就有 3 人会进展为肾衰竭。本研究旨在评估肥胖症患者接受减肥手术后是否会改变 CKD 向肾衰竭的进展。
我们对过去 16 年在我院接受减肥手术的所有患者进行了回顾性分析。通过术前 3 个月和术后 12 个月随访的平均估计肾小球滤过率（eGFR）和尿白蛋白/肌酐比值（uACR）评估肾功能和损伤。使用慢性肾脏病预后联盟（CKD-PC）方程评估从 CKD 进展为肾衰竭的风险。
在这段时间内，对 2924 名患者进行了回顾，其中 69 名（2.4%）患者有记录的数据来评估肾脏损伤和疾病进展为肾衰竭的风险。中重度 CKD 相关白蛋白尿患者在 12 个月随访时改善最大（分别为 48%和 79%；P=0.0001 和 P=0.025）。这意味着在 2 年和 5 年内，CKD≥3 期患者进展为肾衰竭的相对风险降低了 70%和 60%（均 P=0.001）。
减肥手术似乎可以改善肾脏损伤，尤其是在 CKD 最严重的患者中。观察到 CKD 向肾衰竭进展的 2 年和 5 年风险显著降低。
