Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Nephrology (Carlton). 2022 Jan;27(1):44-56. doi: 10.1111/nep.13958. Epub 2021 Aug 16.
The general management for chronic kidney disease (CKD) includes treating reversible causes, including obesity, which may be both a driver and comorbidity for CKD. Bariatric surgery has been shown to reduce the likelihood of CKD progression and improve kidney function in observational studies. We performed a systematic review and meta-analysis of patients with at least stage 3 CKD and obesity receiving bariatric surgery. We searched Embase, MEDLINE, CENTRAL and identified eligible studies reporting on kidney function outcomes in included patients before and after bariatric surgery with comparison to a medical intervention control if available. Risk of bias was assessed with the Newcastle-Ottawa Risk of Bias score. Nineteen studies were included for synthesis. Bariatric surgery showed improved eGFR with a mean difference (MD) of 11.64 (95%CI: 5.84 to 17.45, I = 66%) ml/min/1.73m and reduced SCr with MD of -0.24 (95%CI -0.21 to -0.39, I = 0%) mg/dl after bariatric surgery. There was no significant difference in the relative risk (RR) of having CKD stage 3 after bariatric surgery, with a RR of -1.13 (95%CI: -0.83 to -2.07, I = 13%), but there was reduced likelihood of having uACR >30 mg/g or above with a RR of -3.03 (95%CI: -1.44 to -6.40, I = 91%). Bariatric surgery may be associated with improved kidney function with the reduction of BMI and may be a safe treatment option for patients with CKD. Future studies with more robust reporting are required to determine the feasibility of bariatric surgery for the treatment of CKD.
慢性肾脏病（CKD）的一般管理包括治疗可逆转的病因，包括肥胖症，肥胖症可能既是 CKD 的驱动因素也是其合并症。观察性研究表明，减重手术可降低 CKD 进展的可能性并改善肾功能。我们对至少患有 3 期 CKD 和肥胖症并接受减重手术的患者进行了系统评价和荟萃分析。我们检索了 Embase、MEDLINE、CENTRAL，并确定了符合条件的研究，这些研究报告了纳入患者在接受减重手术前后的肾功能结果，如果有医疗干预对照，则与医疗干预对照进行比较。使用纽卡斯尔-渥太华风险偏倚评分评估风险偏倚。有 19 项研究被纳入进行综合分析。减重手术后，eGFR 改善，平均差异（MD）为 11.64ml/min/1.73m（95%CI：5.84 至 17.45，I ² = 66%），SCr 降低，MD 为 -0.24mg/dl（95%CI：-0.21 至 -0.39，I ² = 0%）。减重手术后发生 3 期 CKD 的相对风险（RR）没有显著差异，RR 为 -1.13（95%CI：-0.83 至 -2.07，I ² = 13%），但 uACR >30mg/g 或更高的可能性降低，RR 为 -3.03（95%CI：-1.44 至 -6.40，I ² = 91%）。减重手术可能与改善肾功能相关，降低 BMI，可能是 CKD 患者的安全治疗选择。需要进一步开展更具说服力的报告的研究来确定减重手术治疗 CKD 的可行性。
