Sørensen Christian Goul, Jensen Simon Kok, Thomsen Reimar Wernich, Jespersen Bente, Gribsholt Sigrid Bjerge, Christiansen Christian Fynbo
Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark.
Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark.
BMC Nephrol. 2025 Aug 13;26(1):458. doi: 10.1186/s12882-025-04378-8.
Bariatric surgery may mitigate obesity-related chronic kidney disease (CKD) but may concurrently increase the risk of acute kidney injury (AKI) and hyperoxaluria. We examined kidney outcomes after bariatric surgery.
Using population-based registries, we included individuals with Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) in Denmark between 2006 and 2018. These were age- and sex-matched 1:5 to individuals with hospital-diagnosed overweight/obesity without bariatric surgery. Cumulative incidences (risks) of AKI, nephrolithiasis, CKD (stage G3-G5), and kidney failure with replacement therapy (KFRT) were computed, accounting for the competing risk of death. Cox regression was used to estimate hazard ratios (HR) adjusted for age, sex, and comorbidity.
We included 18,827 individuals with bariatric surgery (17,200 RYGB and 1,627 SG) and 94,135 individuals in the matched overweight/obesity cohort (median age 41 years, median follow-up 8.1 years). The one-year risk of AKI following bariatric surgery was 2.7%, while the ten-year risks of nephrolithiasis, CKD, and KFRT were 3.5%, 0.4%, and 0.2%, respectively. When comparing individuals with bariatric surgery with those with overweight/obesity, the adjusted HRs were increased at 1.63 (95% CI; 1.38, 1.92) for AKI and 1.73 (95% CI; 1.56, 1.91) for nephrolithiasis. In contrast, adjusted HRs were decreased at 0.41 (95% CI; 0.26, 0.66) for CKD and 0.63 (95% CI; 0.42, 0.95) for KFRT. Similar results were observed versus a population comparison cohort.
Bariatric surgery was associated with an increased risk of AKI and nephrolithiasis, while long-term risks of CKD and KFRT were lower than in matched individuals with overweight/obesity.
减肥手术可能会减轻肥胖相关的慢性肾脏病（CKD），但同时可能会增加急性肾损伤（AKI）和高草酸尿症的风险。我们研究了减肥手术后的肾脏结局。
利用基于人群的登记系统，我们纳入了2006年至2018年期间在丹麦接受Roux-en-Y胃旁路术（RYGB）或袖状胃切除术（SG）的个体。这些个体按年龄和性别1:5与医院诊断为超重/肥胖但未接受减肥手术的个体进行匹配。计算了AKI、肾结石、CKD（G3 - G5期）和需要替代治疗的肾衰竭（KFRT）的累积发病率（风险），并考虑了死亡的竞争风险。采用Cox回归估计调整年龄、性别和合并症后的风险比（HR）。
我们纳入了18,827例接受减肥手术的个体（17,200例RYGB和1,627例SG）以及94,135例匹配的超重/肥胖队列个体（中位年龄41岁，中位随访8.1年）。减肥手术后AKI的一年风险为2.7%，而肾结石、CKD和KFRT的十年风险分别为3.5%、0.4%和0.2%。将接受减肥手术的个体与超重/肥胖个体进行比较时，AKI的调整后HR为1.63（95%CI；1.38, 1.92），肾结石为1.73（95%CI；1.56, 1.91）。相比之下，CKD的调整后HR为0.41（95%CI；0.26, 0.66），KFRT为0.63（95%CI；0.42, 0.95）。与人群比较队列相比观察到类似结果。
减肥手术与AKI和肾结石风险增加相关，而CKD和KFRT的长期风险低于匹配的超重/肥胖个体。
