减重手术后快速体重减轻对慢性肾脏病肥胖患者动脉高血压患病率的影响。
Impact of rapid weight loss after bariatric surgery on the prevalence of arterial hypertension in severely obese patients with chronic kidney disease.
机构信息
Department of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.
出版信息
Surg Endosc. 2020 Jul;34(7):3197-3203. doi: 10.1007/s00464-019-07094-1. Epub 2019 Sep 6.
BACKGROUND
Arterial hypertension (HTN) is one of the most important risk factors for the development and progression of chronic kidney disease (CKD). Rapid weight loss after bariatric interventions has a positive impact on blood pressure levels of hypertensive patients. The aim of our study is to assess the prevalence of HTN in patients with CKD after bariatric surgery (BS).
METHODS
We retrospectively reviewed severely obese patients who underwent BS from 2010 to 2017. We used guidelines of the American College of Cardiology to define HTN. Only patients meeting ACC criteria and the calculation of estimated glomerular filtration rate (eGFR) using CKD epidemiology collaboration study equation preoperatively and at 12-month follow-up were included in the analysis.
RESULTS
From a total of 2900 patients, 29.13% (845) met the required criteria and had variables for the calculation of eGFR recorded preoperatively. 36.92% (312) had preoperative HTN and s classified as CKD stage ≥ 2. We observed a predominantly female population 63.83% (203) with mean age of 54.10 ± 11.58. Patients preoperatively classified in CKD 2, 3a, and 3b exhibited the greatest prevalence reduction of HTN at 12-month follow-up (68.59%, n = 214 vs. 36.59%, n = 114; 16.67%, n = 52 vs. 6.41%, n = 20; 7.69%, n = 24 vs. 1.28%, n = 4; p < 0.0001). A marked improvement in CKD was also observed along with improvement in HTN. The greatest benefit corresponded to patients classified preoperatively in CKD 2, 3a and 3b. A total of n = 70 (62.5%) patients with HTN were classified as CKD 2 preoperatively compared to n = 55 (49.11%) at 12-month follow-up (p = 0.0436). Similarly, n = 22 (19.64%) patients with HTN were classified preoperatively as CKD 3a compared to n = 7 (6.25%) and n = 12 (10.71%) patients as CKD 3b compared to n = 4 (3.57%) during the same time period (p = 0.0028, p = 0.0379, respectively).
CONCLUSIONS
Rapid weight loss after BS significantly reduces prevalence of HTN in all stages of CKD at 12-month follow-up. Additionally, there was a positive impact on classification of CKD at 12-month follow-up.
背景
动脉高血压（HTN）是慢性肾病（CKD）发展和进展的最重要危险因素之一。减重手术后的快速体重减轻对高血压患者的血压水平有积极影响。我们研究的目的是评估肥胖患者在接受减重手术后（BS）后 CKD 患者中 HTN 的患病率。
方法
我们回顾性分析了 2010 年至 2017 年间接受 BS 的严重肥胖患者。我们使用美国心脏病学会的指南来定义 HTN。只有符合 ACC 标准并使用 CKD 流行病学合作研究方程术前和 12 个月随访时计算估计肾小球滤过率（eGFR）的患者才被纳入分析。
结果
在总共 2900 名患者中，29.13%（845 名）符合要求的标准，并记录了术前计算 eGFR 的变量。36.92%（312 名）术前有 HTN，且被归类为 CKD 分期≥2。我们观察到以女性为主的人群 63.83%（203 名），平均年龄为 54.10±11.58 岁。术前在 CKD 2、3a 和 3b 中分类的患者在 12 个月随访时 HTN 的患病率降低最大（68.59%，n=214 比 36.59%，n=114；16.67%，n=52 比 6.41%，n=20；7.69%，n=24 比 1.28%，n=4；p<0.0001）。同时，CKD 的显著改善也伴随着 HTN 的改善。最大的益处对应于术前在 CKD 2、3a 和 3b 中分类的患者。共有 n=70（62.5%）例术前有 HTN 的患者被归类为 CKD 2，而 n=55（49.11%）例在 12 个月随访时被归类为 CKD 2（p=0.0436）。同样，术前有 HTN 的 n=22（19.64%）例患者被归类为 CKD 3a，而 n=7（6.25%）例和 n=12（10.71%）例患者被归类为 CKD 3b，而 n=4（3.57%）例在同一时期（p=0.0028，p=0.0379）。
结论
BS 后快速体重减轻在 12 个月随访时显著降低了 CKD 所有阶段的 HTN 患病率。此外，对 12 个月随访时 CKD 的分类也有积极影响。
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