Department of Nuclear Medicine, University Hospital of Nice, Archet 1 Hospital, Nice, France.
Department of Pharmacy, University Hospital, Nice, France.
PLoS One. 2021 Aug 16;16(8):e0256234. doi: 10.1371/journal.pone.0256234. eCollection 2021.
Bariatric surgery (BS) might be a nephroprotective treatment in obese patients with chronic kidney disease (CKD), and the non-linear relation between body surface area (BSA) and extracellular fluid volume (ECFV) in obese people raises the question of the most relevant way to scale glomerular filtration rate (GFR) for assessing renal function changes after BS.
We screened 1774 BS candidates and analysed 10 consecutive participants with CKD stage 3. True GFR (mGFR), measured by the renal clearance of 51Cr-ethylenediaminetetraacetic acid (EDTA), was scaled either to BSA (mGFRBSA) or to ECFV measured by 51Cr-EDTA distribution volume (mGFRECFV) before and one year after BS.
The 10 candidates for BS had a mean body mass index of 43.3 ± 3.6 kg/m2 and a mean GFR of 48 ± 8 mL/min/1.73 m2. Six participants had a sleeve gastrectomy and four had a Roux-en-Y gastric bypass. One year after BS, ECFV decreased (23.2 ± 6.2 to 17.9 ± 4.3 L, p = 0.001), absolute mGFR was not significantly modified (74 ± 23 versus 68 ±19 mL/min), mGFRBSA did not change significantly (53 ± 18 versus 56 ± 17 mL/min/1.73 m2) whereas mGFRECFV significantly increased (42 ± 13 versus 50 ± 14 mL/min/12.9 L, p = 0.037). The relation between mGFRECFV and mGFRBSA was different from the identity line before (p = 0.014) but not after BS (p = 0.09).
There is a difference between mGFRBSA and mGFRECFV following BS and the latter might better reflect the adequacy between renal function and corpulence.
肥胖合并慢性肾脏病（CKD）患者行减重手术（BS）可能具有肾脏保护作用，肥胖人群的体表面积（BSA）与细胞外液容量（ECFV）之间存在非线性关系，这使得在评估 BS 后肾功能变化时，肾小球滤过率（GFR）的最佳标化方式成为一个问题。
我们筛选了 1774 名 BS 候选者，并对 10 名连续的 CKD 3 期患者进行了分析。通过 51Cr-乙二胺四乙酸（EDTA）肾清除率测量的真 GFR（mGFR），分别按 BSA（mGFRBSA）或 51Cr-EDTA 分布容积（mGFRECFV）进行标化，BS 前和 BS 后 1 年均进行了测量。
10 名 BS 候选者的平均 BMI 为 43.3 ± 3.6 kg/m2，平均 GFR 为 48 ± 8 mL/min/1.73 m2。6 名患者行袖状胃切除术，4 名患者行 Roux-en-Y 胃旁路术。BS 后 1 年，ECFV 减少（23.2 ± 6.2 至 17.9 ± 4.3 L，p = 0.001），绝对 mGFR 无明显改变（74 ± 23 至 68 ±19 mL/min），mGFRBSA 无明显变化（53 ± 18 至 56 ± 17 mL/min/1.73 m2），但 mGFRECFV 明显增加（42 ± 13 至 50 ± 14 mL/min/12.9 L，p = 0.037）。BS 前后 mGFRECFV 与 mGFRBSA 之间的关系与直线不同（p = 0.014），BS 后则相同（p = 0.09）。
BS 后 mGFRBSA 与 mGFRECFV 之间存在差异，后者可能更好地反映肾功能与肥胖程度之间的适应性。
