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慢性肾脏病患者的减肥手术结果

Bariatric Surgery Outcomes in Patients with Chronic Kidney Disease.

作者信息

Pané Adriana, Claro Maria, Molina-Andujar Alicia, Olbeyra Romina, Romano-Andrioni Bárbara, Boswell Laura, Montagud-Marrahi Enrique, Jiménez Amanda, Ibarzabal Ainitze, Viaplana Judith, Ventura-Aguiar Pedro, Amor Antonio J, Vidal Josep, Flores Lilliam, de Hollanda Ana

机构信息

Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Villarroel 170, 08036 Barcelona, Spain.

Centro de Investigación Biomédica en Red de la Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain.

出版信息

J Clin Med. 2023 Sep 21;12(18):6095. doi: 10.3390/jcm12186095.

Abstract

Obesity increases the risk of developing chronic kidney disease (CKD), which has a major negative impact on global health. Bariatric surgery (BS) has demonstrated a substantial improvement of obesity-related comorbidities and thus, it has emerged as a potential therapeutic tool in order to prevent end-stage renal disease. A limited number of publications to date have examined the beneficial effects and risks of BS in patients with non-advanced stages of CKD. We aimed to investigate the safety of BS in patients with CKD stages 3-4 (directly related or not to obesity) and both the metabolic/renal outcomes post-BS. A total of 57 individuals were included (n = 19 for CKD-group; n = 38 for patients with obesity, but normal eGFR [control-group]). Weight loss and obesity comorbidities resolution after BS were similar in both groups. Renal function (eGFR [CKD-EPI]) improved significantly at the 1-year follow-up: Δ10.2 (5.2-14.9) ( < 0.001) for CKD-group and Δ4.0 (-3.9-9.0) mL/min/1.73 m ( = 0.043) for controls. Although this improvement tended to decrease in the 5-year follow-up, eGFR remained above its basal value for the CKD-group. Noteworthy, eGFR also improved in those patients who presented CKD not directly attributed to obesity. For patients with CKD, BS appears to be safe and effective regarding weight loss and obesity comorbidities resolution, irrespective of the main cause of CKD (related or not to obesity).

摘要

肥胖会增加患慢性肾脏病(CKD)的风险,这对全球健康有重大负面影响。减重手术(BS)已显示出对肥胖相关合并症有显著改善,因此,它已成为预防终末期肾病的一种潜在治疗手段。迄今为止,仅有少数出版物研究了BS对非晚期CKD患者的益处和风险。我们旨在调查BS对3 - 4期CKD患者(无论是否与肥胖直接相关)的安全性以及BS后的代谢/肾脏结局。总共纳入了57名个体(CKD组19例;肥胖但估算肾小球滤过率正常的患者组[对照组]38例)。两组患者在BS后的体重减轻和肥胖合并症缓解情况相似。在1年随访时,肾功能(估算肾小球滤过率[CKD-EPI])显著改善:CKD组为Δ10.2(5.2 - 14.9)(<0.001),对照组为Δ4.0(-3.9 - 9.0)mL/min/1.73 m²(P = 0.043)。尽管这种改善在5年随访中趋于下降,但CKD组的估算肾小球滤过率仍高于其基础值。值得注意的是,在那些CKD并非直接由肥胖引起的患者中,估算肾小球滤过率也有所改善。对于CKD患者,无论CKD的主要病因(是否与肥胖相关)如何,BS在减重和解决肥胖合并症方面似乎都是安全有效的。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d5d8/10532233/0b42d765e2aa/jcm-12-06095-g001.jpg

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