Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
The Center for Obesity and Diabetes, Oswaldo Cruz German Hospital, São Paulo, Brazil.
Curr Opin Nephrol Hypertens. 2019 Nov;28(6):537-544. doi: 10.1097/MNH.0000000000000539.
Through its direct adverse effects on the kidney and via associated intermediate disease states like type 2 diabetes and hypertension, obese has arguably become the master risk factor for chronic kidney disease (CKD). The purpose of this review is to critically evaluate bariatric surgery, which is the most effective weight reduction strategy available, as a renoprotective strategy.
Recent randomized studies confirm that bariatric surgery is effective at improving or even remitting major CKD risk factors such as type 2 diabetes and hypertension. In addition, observational studies performed primarily in patients without preexisting CKD report improvements in estimated glomerular filtration rate and albuminuria after bariatric surgery. Yet this literature is limited by study design, participant selection, statistical power, and measurement issues that must be overcome to better define kidney-related benefits, especially with regard to harder kidney-related and other clinical endpoints.
Encouraging data exist on the renoprotective effects of bariatric surgery. However, important knowledge gaps still remain. Future research should focus on studying, ideally in randomized fashion, the renoprotective effects of bariatric surgery in patients with preexisting CKD to better define the benefit-risk ratio for each patient.
肥胖通过直接影响肾脏，以及相关的中间疾病状态，如 2 型糖尿病和高血压，已成为慢性肾脏病（CKD）的主要危险因素。本文的目的是批判性地评估减重手术，作为最有效的减肥策略，作为一种肾脏保护策略。
最近的随机研究证实，减重手术可有效改善甚至逆转 2 型糖尿病和高血压等主要 CKD 危险因素。此外，主要在没有预先存在 CKD 的患者中进行的观察性研究报告，减重手术后估算肾小球滤过率和白蛋白尿得到改善。然而，该文献受到研究设计、参与者选择、统计能力和测量问题的限制，这些问题必须得到解决，才能更好地确定与肾脏相关的益处，特别是在更难的与肾脏相关和其他临床终点方面。
减重手术具有肾脏保护作用的令人鼓舞的数据仍然存在。然而，仍存在重要的知识空白。未来的研究应集中在研究，理想情况下是随机研究，在有预先存在的 CKD 的患者中，减重手术的肾脏保护作用，以更好地定义每个患者的获益风险比。
