慢性肾脏病患者减肥手术后肾功能和体重指数前后的关系。
The relationship between kidney function and body mass index before and after bariatric surgery in patients with chronic kidney disease.
机构信息
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California.
Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, California.
出版信息
Surg Obes Relat Dis. 2021 Mar;17(3):508-515. doi: 10.1016/j.soard.2020.11.010. Epub 2020 Nov 19.
BACKGROUND
Improvements in kidney function post-bariatric surgery may be related to weight loss-independent effects.
OBJECTIVES
To characterize the dynamic relationship between body mass index (BMI) and estimated glomerular filtration rate (eGFR) before and after bariatric surgery in patients with chronic kidney disease (CKD).
SETTING
Kaiser Permanente Southern California (KPSC) health system.
METHODS
We conducted an observational, retrospective cohort study of patients with CKD stage 3 or higher who received bariatric surgery at the KPSC health system between 2007-2015. Bariatric surgery procedures included primary Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) procedures. Outcomes consisted of mean trajectory estimates and correlations of BMI and eGFR taken between 2 years before and 3 years after surgery. Multivariate functional mixed models were used to estimate how BMI and eGFR trajectories evolved jointly.
RESULTS
A total of 619 RYGB and 474 SG patients were included in the final analytic sample. The measurements were available before surgery for a median time of 1.9 years for SG and 1.8 years for RYGB patients. Median follow-up times after surgery were 2.8 years for both SG and RYGB patients. The mean age at the time of surgery was 58 years; 77% of patients were women; 56% of patients were non-Hispanic White; the mean BMI was 44 kg/m; 60% of patients had diabetes mellitus; and 84% of patients had hypertension. Compared to the presurgery eGFR declines, the postsurgery declines in eGFR were 57% slower (95% credible interval [CrI], 33%-81%) for RYGB patients and 55% slower (95% CrI, 25%-75%) for SG patients. The mean correlation between BMI and eGFR was negligible at all time points.
CONCLUSION
Though bariatric surgery slowed declines in eGFR up to 3 years after surgery, changes in eGFR tracked poorly with changes in BMI. This study provides evidence that the kidney-related benefits of bariatric surgery may be at least partly independent of weight loss. Confirming this hypothesis could lead to mechanistic insights and new treatment options for CKD.
背景
减重手术后肾功能的改善可能与体重减轻无关的影响有关。
目的
描述慢性肾脏病（CKD）患者接受减重手术后 BMI 和估算肾小球滤过率（eGFR）的动态关系。
设置
凯撒永久南加州（KPSC）医疗系统。
方法
我们对 2007 年至 2015 年间在 KPSC 医疗系统接受减重手术的 CKD 3 期或更高期患者进行了一项观察性、回顾性队列研究。减重手术包括主要 Roux-en-Y 胃旁路术（RYGB）或袖状胃切除术（SG）。结果包括手术前 2 年至手术后 3 年之间的 BMI 和 eGFR 平均轨迹估计值和相关性。使用多元功能混合模型来估计 BMI 和 eGFR 轨迹如何共同演变。
结果
共纳入 619 例 RYGB 和 474 例 SG 患者作为最终分析样本。SG 和 RYGB 患者手术前的测量中位数时间分别为 1.9 年和 1.8 年。SG 和 RYGB 患者手术后的中位随访时间分别为 2.8 年。手术时的平均年龄为 58 岁；77%的患者为女性；56%的患者为非西班牙裔白人；平均 BMI 为 44kg/m；60%的患者患有糖尿病；84%的患者患有高血压。与术前 eGFR 下降相比，RYGB 患者术后 eGFR 下降速度慢 57%（95%可信区间[CrI]，33%-81%），SG 患者术后 eGFR 下降速度慢 55%（95%CrI，25%-75%）。在所有时间点，BMI 和 eGFR 之间的平均相关性都可以忽略不计。
结论
尽管减重手术在手术后 3 年内减缓了 eGFR 的下降，但 eGFR 的变化与 BMI 的变化相关性较差。本研究提供的证据表明，减重手术对肾脏的益处至少部分独立于体重减轻。证实这一假设可能会为 CKD 带来机制上的见解和新的治疗选择。
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