Service d'Hépato-Gastroentérologie Et Nutrition, Hôpital Antoine-Béclère, AP-HP Université Paris-Saclay, Clamart, France.
INSERM U996, FHU Hepatinov, Labex LERMIT, Clamart, France.
Langenbecks Arch Surg. 2022 Dec;407(8):3323-3332. doi: 10.1007/s00423-022-02647-w. Epub 2022 Aug 9.
Obesity is an independent risk factor for renal injury. A more favorable metabolic environment following weight loss may theoretically lead to improved renal function. We aimed to evaluate the evolution of renal function one year after sleeve gastrectomy in a large prospective cohort of patients with morbid obesity and assess the influence of fat-free mass (FFM) changes.
We prospectively included obese patients admitted for sleeve gastrectomy between February 2014 and November 2016. We also included a historical observational cohort of patients undergoing sleeve gastrectomy between January 2013 and January 2014 who had FFM evaluation. Patients were systematically evaluated 1 year after surgery. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. The FFM was estimated by analyzing computerized tomography (CT) scan sections from CT systematically performed 2 days and 1 year after sleeve gastrectomy to detect surgery complications.
Five hundred sixty-three patients fulfilled the inclusion criteria. The mean age was 41.2 ± 0.5 years. The mean body mass index was 43.5 ± 0.3 kg/m and 20.4, 30.5, and 30.7% of the included patients had type 2 diabetes, hypertension, and dyslipidemia, respectively. One hundred fifteen patients were excluded and four hundred forty-eight patients were finally included in the analysis. The eGFR was significantly higher 1 year after sleeve gastrectomy than before surgery (87.8 ± 0.9 versus 86.1 ± 0.9, p < 0.01). There was no difference in terms of post-surgery FFM loss between patients with an improved eGFR and those without (6.7 ± 0.3 kg versus 6.8 ± 0.5 kg, p = 0.9). Furthermore, post-surgery changes in the eGFR did not correlate with the amount of FFM loss (r = 0.1, p = 0.18).
Renal function assessed by eGFR is significantly improved at 1-year post-sleeve gastrectomy, independent of changes in skeletal muscle mass.
肥胖是肾脏损伤的一个独立危险因素。理论上，减肥后更有利的代谢环境可能会导致肾功能改善。我们旨在评估在肥胖患者中，袖状胃切除术 1 年后肾功能的演变，并评估去脂体重（FFM）变化的影响。
我们前瞻性纳入了 2014 年 2 月至 2016 年 11 月间因袖状胃切除术而入院的肥胖患者。同时，我们还纳入了 2013 年 1 月至 2014 年 1 月间接受袖状胃切除术且有 FFM 评估的历史对照队列。所有患者术后 1 年均进行系统评估。肾小球滤过率（eGFR）通过慢性肾脏病流行病学协作（CKD-EPI）方程进行计算。FFM 通过分析术后 2 天和 1 年的计算机断层扫描（CT）扫描，以检测手术并发症来评估。
563 名患者符合纳入标准。平均年龄为 41.2±0.5 岁。平均体重指数为 43.5±0.3kg/m，分别有 20.4%、30.5%和 30.7%的患者患有 2 型糖尿病、高血压和血脂异常。115 名患者被排除，最终 448 名患者纳入分析。袖状胃切除术后 1 年 eGFR 显著高于术前（87.8±0.9 比 86.1±0.9，p<0.01）。术后 eGFR 改善患者和未改善患者的 FFM 丢失量无差异（6.7±0.3kg 比 6.8±0.5kg，p=0.9）。此外，术后 eGFR 的变化与 FFM 丢失量无相关性（r=0.1，p=0.18）。
袖状胃切除术 1 年后，通过 eGFR 评估的肾功能显著改善，与骨骼肌质量变化无关。
