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Higgins MS, Ismail S, Chen M, Agala CB, Detwiler R, Farrell TM, Hodges MM. Evaluating the safety of bariatric surgery as a bridge to kidney transplant: a retrospective cohort study. Surg Endosc 2024:10.1007/s00464-024-11087-0. [PMID: 39085668 DOI: 10.1007/s00464-024-11087-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 07/13/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Bariatric surgery has been proven safe in end-stage kidney disease (ESKD); however, few studies have evaluated whether a history of bariatric surgery impacts transplant-specific outcomes. We hypothesize that a history of bariatric surgery at the time of transplant does not adversely impact transplant-specific outcomes. METHODS The IBM MarketScan Commercial Claims and Encounters database was queried for patients with a history of kidney transplant between 2000 and 2021. Patients were stratified into three groups based on bariatric surgery status and body mass index (BMI) at the time of transplant: patients with obesity (O), patients without obesity (NO), and patients with a history of bariatric surgery (BS). Inverse probability of treatment weighting was used to control for confounding. Adjusted hazard ratios (aHRs) describing the risk of transplant-specific and postoperative outcomes were estimated using weighted Kaplan-Meier curves. Primary outcomes included 30-day and 1-year risk of transplant-specific outcomes. Secondary outcomes included 30-day and 1-year postoperative complications and 30-day and 1-year risk of wound-related complications. RESULTS We identified 14,806 patients; 128 in the BS group, 1572 in the O group, and 13,106 in the NO group. There was no difference in 30-day or 1-year risk of transplant-specific complications between the BS and NO group or the O and NO group. Patients with obesity (O) were more likely to experience wound infection (aHR 1.49, 95% CI 1.12-1.99), wound dehiscence (aHR 2.2, 95% CI 1.5-3.2), and minor reoperation (aHR 1.52, 95% CI 1.23-1.89) at 1 year. BS patients had increased risk of wound infection at 1 year (aHR 2.79, 95% CI 1.26-6.16), but were without increase in risk of minor or major reoperation. CONCLUSION A history of bariatric surgery does not adversely affect transplant-specific outcomes after kidney transplant. Bariatric surgery can be safely utilized to improve the transplant candidacy of patients with obesity with CKD and ESKD.
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Affiliation(s)
- Madeleine S Higgins
- Division of Gastrointestinal Surgery, Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Sherin Ismail
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Melissa Chen
- Division of Abdominal Transplantation, Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Chris B Agala
- Division of Gastrointestinal Surgery, Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Randal Detwiler
- Division of Nephrology and Hypertension, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Timothy M Farrell
- Division of Gastrointestinal Surgery, Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Maggie M Hodges
- Division of Gastrointestinal Surgery, Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, USA.
- Division of Gastrointestinal Surgery, Department of Surgery, The University of North Carolina at Chapel Hill, Burnett Womack Bldg, Suite 4034, 101 Manning Drive, Chapel Hill, NC, 27599-7081, USA.
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2
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Mills DW, Woolley DM, Ammori BJ, Chinoy H, Syed AA. Changes in Serum Urate Levels after Bariatric Surgery in Patients with Obesity: An Observational Study. Obes Surg 2024; 34:1737-1741. [PMID: 38528214 PMCID: PMC11031430 DOI: 10.1007/s11695-024-07191-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Obesity is a risk factor for hyperuricemia and gout, while weight reduction can reduce urate levels. The aim of this study was to examine the effect of bariatric surgery on longitudinal serum urate levels. METHODS We performed a retrospective observational study of 283 patients who had undergone bariatric surgery [237 (83.7%) gastric bypass, 34 (12.0%) sleeve gastrectomy and 12 (4.2%) gastric banding] and were followed up for 2 years. The results shown represent mean (standard deviation). RESULTS Bariatric surgery was associated with significant reduction in serum urate from baseline level of 0.343 (0.086) mmol/L to 0.296 (0.076) mmol/L (p < 0.001) at 12 months and 0.286 (0.073) mmol/L (p < 0.001) at 24 months, including in men and women, and in patients with or without diabetes. Patients with elevated urate levels at baseline, who comprised 27.2% of the total cohort, achieved reduction in levels by 4 months. CONCLUSION Bariatric surgery leads to significant reduction in serum urate levels at 12 and 24 months. This could reduce incidence of gout and need for prophylactic medication(s).
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Affiliation(s)
- Daniel W Mills
- General (Internal) Medicine, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Dylan M Woolley
- General (Internal) Medicine, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Basil J Ammori
- Metabolic and Bariatric Surgery, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Metabolic and Bariatric Surgery, Burjeel Hospital, Burjeel Holdings, Abu Dhabi, UAE
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Hector Chinoy
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Akheel A Syed
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
- Diabetes, Endocrinology and Obesity Medicine, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK.
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3
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Li Z, Chen Y, Xiong J, Lyu Q, Jiang B. Renal Function Following Bariatric Surgery: a Literature Review of Potential Mechanisms. Obes Surg 2022; 32:1734-1740. [PMID: 35243602 DOI: 10.1007/s11695-022-05985-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 02/17/2022] [Accepted: 02/17/2022] [Indexed: 11/26/2022]
Abstract
Obesity is a major and independent risk factor for onset and progression of many renal diseases. Bariatric surgery (BS) improves renal function by improving obesity-related metabolic disorders. However, the procedure is also accompanied by renal risks, including acute kidney injury (AKI) and oxalate nephropathy. Here, we briefly review the history and principle of frequently applied technique for BS and summarize the comprehensive BS effect on kidney function. Importantly, we highlight the possible molecular mechanisms associated with the recovery of renal function to provide novel ideas for future studies and clinical applications.
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Affiliation(s)
- Zhixin Li
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Yu Chen
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Jinming Xiong
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Qinglan Lyu
- Department of Pathophysiology, Sepsis Translational Medicine Key Laboratory of Hunan Province, Xiangya School of Medicine, Central South University, Changsha, 410013, China.
| | - Bimei Jiang
- Department of Pathophysiology, Sepsis Translational Medicine Key Laboratory of Hunan Province, Xiangya School of Medicine, Central South University, Changsha, 410013, China.
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4
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Exploring Renal Changes after Bariatric Surgery in Patients with Severe Obesity. J Clin Med 2022; 11:jcm11030728. [PMID: 35160179 PMCID: PMC8837063 DOI: 10.3390/jcm11030728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/24/2022] [Accepted: 01/27/2022] [Indexed: 02/04/2023] Open
Abstract
Obesity-related hyperfiltration leads to an increased glomerular filtration rate (GFR) and hyperalbuminuria. These changes are reversible after bariatric surgery (BS). We aimed to explore obesity-related renal changes post-BS and to seek potential mechanisms. Sixty-two individuals with severe obesity were prospectively examined before and 3, 6 and 12 months post-BS. Anthropometric and laboratory data, 24 h-blood pressure, renin-angiotensin-aldosterone system (RAS) components, adipokines and inflammatory markers were determined. Both estimated GFR (eGFR) and albuminuria decreased from the baseline at all follow-up times (p-for-trend <0.001 for both). There was a median (IQR) of 30.5% (26.2–34.4) reduction in body weight. Plasma glucose, glycosylated hemoglobin, fasting insulin and HOMA-index decreased at 3, 6 and 12 months of follow-up (p-for-trend <0.001 for all). The plasma aldosterone concentration (median (IQR)) also decreased at 12 months (from 87.8 ng/dL (56.8; 154) to 65.4 (56.8; 84.6), p = 0.003). Both leptin and hs-CRP decreased (p < 0.001) and adiponectine levels increased at 12 months post-BS (p = 0.017). Linear mixed-models showed that body weight (coef. 0.62, 95% CI: 0.32 to 0.93, p < 0.001) and plasma aldosterone (coef. −0.07, 95% CI: −0.13 to −0.02, p = 0.005) were the independent variables for changes in eGFR. Conversely, glycosylated hemoglobin was the only independent variable for changes in albuminuria (coef. 0.24, 95% CI: 0.06 to 0.42, p = 0.009). In conclusion, body weight and aldosterone are the main factors that mediate eGFR changes in obesity and BS, while albuminuria is associated with glucose homeostasis.
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5
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García Ruiz de Gordejuela A, Ibarzabal A, Osorio J. Bariatric Surgery and Solid-Organ Transplantation. Transplant Proc 2022; 54:87-90. [PMID: 34973842 DOI: 10.1016/j.transproceed.2021.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/16/2021] [Accepted: 11/17/2021] [Indexed: 12/25/2022]
Abstract
Morbid obesity and being overweight are a growing problem worldwide. They also affect patients with end-stage solid-organ disease and patients after transplant. Bariatric surgery is the most effective available weight loss procedure. Bariatric surgery can be helpful for the treatment of some conditions, such as nonalcoholic fatty liver disease or nonalcoholic steatohepatitis, which may lead to transplant, and weight loss can improve or even reverse them. In other cases, morbid obesity is a limitation to accessing a transplant program, so bariatric surgery can serve as a conduit to transplant. After transplant, obesity and obesity-related comorbidities can be a significant health problem that may be treated, as in patients without a transplant, with bariatric surgery. There are some specific conditions and issues to be considered in patients with end-stage solid-organ disease who are candidates for bariatric surgery, such as increased morbidity and mortality. After transplant, immunosuppressant regimens and technical limitations may be also significant.
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Affiliation(s)
- Amador García Ruiz de Gordejuela
- Bariatric Surgery Unit, General Surgery Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain.
| | - Ainitze Ibarzabal
- Gastrointestinal Surgery Department, Clinic Hospital Barcelona, University of Barcelona, Barcelona, Spain
| | - Javier Osorio
- Bariatric Surgery Unit, General Surgery Department, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
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6
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Climent E, Oliveras A, Pedro-Botet J, Goday A, Benaiges D. Bariatric Surgery and Hypertension. J Clin Med 2021; 10:jcm10184049. [PMID: 34575161 PMCID: PMC8467380 DOI: 10.3390/jcm10184049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/25/2021] [Accepted: 09/07/2021] [Indexed: 12/14/2022] Open
Abstract
A clear pathogenetic association exists between obesity and arterial hypertension, becoming even more evident in subjects with severe obesity. Bariatric surgery has proved to be the most effective treatment for severe obesity, with its benefits going beyond weight loss. The present review aimed to determine the effects of bariatric surgery on arterial hypertension evident in short- and long-term follow-ups. Moreover, the differences between surgical techniques regarding hypertension remission are described as well as the possible pathophysiologic mechanisms involved. In addition, the effects of bariatric surgery beyond blood pressure normalization are also analyzed, including those on target organs and cardiovascular morbidity and mortality.
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Affiliation(s)
- Elisenda Climent
- Endocrinology Department, Hospital Universitari del Mar, 08003 Barcelona, Spain; (E.C.); (J.P.-B.); (A.G.)
- IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain;
- Department of Medicine, Universitat Autònoma de Barcelona, 08139 Barcelona, Spain
| | - Anna Oliveras
- IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain;
- Nephrology Department, Hospital Universitari del Mar, 08003 Barcelona, Spain
- Department of Experimental and Health Sciences, Area of Medicine, Universitat Pompeu Fabra, 08002 Barcelona, Spain
- Red de Investigación Renal (REDINREN), Instituto Carlos III-FEDER, 28029 Madrid, Spain
| | - Juan Pedro-Botet
- Endocrinology Department, Hospital Universitari del Mar, 08003 Barcelona, Spain; (E.C.); (J.P.-B.); (A.G.)
- IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain;
- Department of Medicine, Universitat Autònoma de Barcelona, 08139 Barcelona, Spain
| | - Albert Goday
- Endocrinology Department, Hospital Universitari del Mar, 08003 Barcelona, Spain; (E.C.); (J.P.-B.); (A.G.)
- IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain;
- Department of Medicine, Universitat Autònoma de Barcelona, 08139 Barcelona, Spain
- Centro de Investigaciones Biomédicas en Red de Obesidad y Nutrición, CIBERobn, 28029 Madrid, Spain
| | - David Benaiges
- Endocrinology Department, Hospital Universitari del Mar, 08003 Barcelona, Spain; (E.C.); (J.P.-B.); (A.G.)
- IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain;
- Department of Medicine, Universitat Autònoma de Barcelona, 08139 Barcelona, Spain
- Consorci Sanitari de l’Alt Penedès i Garraf, 08720 Vilafranca del Penedès, Spain
- Correspondence: ; Tel.: +34-93-248-3902; Fax: +34-93-248-3254
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7
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Welsh LK, Luhrs AR, Davalos G, Diaz R, Narvaez A, Perez JE, Lerebours R, Kuchibhatla M, Portenier DD, Guerron AD. Racial Disparities in Bariatric Surgery Complications and Mortality Using the MBSAQIP Data Registry. Obes Surg 2021; 30:3099-3110. [PMID: 32388704 PMCID: PMC7223417 DOI: 10.1007/s11695-020-04657-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Racial disparities in postoperative complications have been demonstrated in bariatric surgery, yet the relationship of race to complication severity is unknown. Study Design Adult laparoscopic primary bariatric procedures were queried from the 2015 and 2016 MBSAQIP registry. Adjusted logistic and multinomial regressions were used to examine the relationships between race and 30-day complications categorized by the Clavien-Dindo grading system. Results A total of 212,970 patients were included in the regression analyses. For Black patients, readmissions were higher (OR = 1.39, p < 0.0001) and the odds of a Grade 1, 3, 4, or 5 complication were increased compared with White patients (OR = 1.21, p < 0.0001; OR = 1.21, p < 0.0001; OR = 1.22, p = 0.01; and OR = 1.43, p = 0.04) respectively. The odds of a Grade 3 complication for Hispanic patients were higher compared with White patients (OR = 1.59, p < 0.0001). Conclusion Black patients have higher odds of readmission and multiple grades of complications (including death) compared with White patients. Hispanic patients have higher odds of a Grade 3 complication compared with White patients. No significant differences were found with other races. Specific causes of these disparities are beyond the limitations of the dataset and stand as a topic for future inquiry.
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Affiliation(s)
- Leonard K Welsh
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, 407 Crutchfield St., Durham, NC, 27704, USA
| | - Andrew R Luhrs
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, 407 Crutchfield St., Durham, NC, 27704, USA
| | - Gerardo Davalos
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, 407 Crutchfield St., Durham, NC, 27704, USA
| | - Ramon Diaz
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, 407 Crutchfield St., Durham, NC, 27704, USA
| | - Andres Narvaez
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, 407 Crutchfield St., Durham, NC, 27704, USA
| | - Juan Esteban Perez
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, 407 Crutchfield St., Durham, NC, 27704, USA
| | - Reginald Lerebours
- Department of Biostatistics and Bioinformatics, Duke University, 2424 Erwin Rd, Durham, 27710, USA
| | - Maragatha Kuchibhatla
- Department of Biostatistics and Bioinformatics, Duke University, 2424 Erwin Rd, Durham, 27710, USA
| | - Dana D Portenier
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, 407 Crutchfield St., Durham, NC, 27704, USA
| | - Alfredo D Guerron
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, 407 Crutchfield St., Durham, NC, 27704, USA.
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8
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Welsh LK, Davalos G, Diaz R, Narvaez A, Perez JE, Castro M, Kuchibhatla M, Risoli T, Portenier D, Guerron AD. Magnetic Liver Retraction Decreases Postoperative Pain and Length of Stay in Bariatric Surgery Compared to Nathanson Device. J Laparoendosc Adv Surg Tech A 2020; 31:194-202. [PMID: 32678701 DOI: 10.1089/lap.2020.0388] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Objective: Retrospective case-matched comparison of magnetic liver retraction to a bedrail-mounted liver retractor in bariatric surgery specifically targeting short-term postoperative outcomes, including pain and resource utilization. Background: Retraction of the liver is essential to ensure appropriate visualization of the hiatus in bariatric surgery. Externally mounted retractors require a dedicated port or an additional incision. Magnetic devices provide effective liver retraction without the need of an incision. Methods: The sample consisted of primary and revisional bariatric surgery patients, including Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and biliopancreatic diversion with duodenal switch (BPD-DS) operations. Propensity score analysis was used to match patients with magnetic retraction to patients with a bedrail-mounted retractor with a 1:2 ratio using preoperative characteristics. Baseline characteristics and postprocedure outcomes were compared using two-sample t-tests or Wilcoxon rank sum tests and chi-square or Fisher's exact test as appropriate. Results: One hundred patients met inclusion criteria for the use of magnetic liver retraction (45 RYGB, 35 SG, 20 BPD-DS) with 196 suitable matched external retractor patients identified. Patients were matched and comparable for all preoperative characteristics except for transversus abdominus plane block (27% versus 47%). Patients in the magnet cohort had significantly decreased mean 12-hour postoperative pain scores (2.9 versus 4.2, P = .004) and decreased hospital length of stay (LOS) (1.5 versus 1.9 days, P = .005) while operating room supply were higher in the magnet cohort ($4600 versus $4213, P = .0001). Conclusions: Magnetic liver retraction in bariatric surgery is associated with decreased postoperative pain scores, decreased hospital LOS, and increased operating supply costs.
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Affiliation(s)
- Leonard K Welsh
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Gerardo Davalos
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Ramon Diaz
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Andres Narvaez
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Juan Esteban Perez
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Melissa Castro
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Maragatha Kuchibhatla
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Thomas Risoli
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Dana Portenier
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Alfredo D Guerron
- Division of Metabolic and Weight Loss Surgery, Department of Surgery, Duke University, Durham, North Carolina, USA
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9
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Miranda A, Rosato A, Costanzi A, Pisano L, Colzani S, Auricchio S, Mari G, Achilli P, Maggioni D. Case Report: Acute kidney failure leading to permanent haemodialysis due to hyperoxaluria following one-anastomosis gastric bypass-related rapid weight loss. F1000Res 2020; 9:155. [PMID: 32528660 PMCID: PMC7265574 DOI: 10.12688/f1000research.22109.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2020] [Indexed: 11/20/2022] Open
Abstract
The one-anastomosis gastric bypass (OAGB) has been proven to provide good weight loss, comorbidity improvement, and quality of life with follow-up longer than five years. Although capable of improving many obesity-related diseases, OAGB is associated with post-operative medical complications mainly related to the induced malabsorption. A 52-year-old man affected by nephrotic syndrome due to a focal segmental glomerulosclerosis underwent OAGB uneventfully. At three months post-surgery, the patient had lost 40kg, reaching a BMI of 32. The patient was admitted to the nephrology unit for acute kidney injury with only mild improvement in renal function (SCr 9 mg/dl); proteinuria was still elevated (4g/24h), with microhaematuria. A renal biopsy was performed: oxalate deposits were demonstrated inside tubules, associated with acute and chronic tubular and interstitial damage and glomerulosclerosis (21/33 glomeruli). Urinary oxalate levels were found to be elevated (72mg/24h, range 13-40), providing the diagnosis of acute kidney injury due to hyperoxaluria, potentially associated to OAGB. No recovery in renal function was observed and the patient remained dialysis dependent. Early and rapid excessive weight loss in patients affected by chronic kidney insufficiency could be associated with the worsening of renal function. Increased calcium oxalate levels associated with OAGB-related malabsorption could be a key factor in kidney injury.
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Affiliation(s)
- Angelo Miranda
- General Surgery Departement, Desio Hospital, Desio, Italy, 20843, Italy
| | - Andrea Rosato
- General Surgery Departement, Desio Hospital, Desio, Italy, 20843, Italy
| | - Andrea Costanzi
- General Surgery Departement, Desio Hospital, Desio, Italy, 20843, Italy
| | - Lucia Pisano
- Nephrological Unit, Desio Hospital, Desio, Italy, 20843, Italy
| | - Sara Colzani
- Nephrological Unit, Desio Hospital, Desio, Italy, 20843, Italy
| | - Sara Auricchio
- Nephrological Unit, Desio Hospital, Desio, Italy, 20843, Italy
| | - Giulio Mari
- General Surgery Departement, Desio Hospital, Desio, Italy, 20843, Italy
| | - Pietro Achilli
- Univerity of Milan, Residency in general Surgery, Milano, Italy, 20100, Italy
| | - Dario Maggioni
- General Surgery Departement, Desio Hospital, Desio, Italy, 20843, Italy
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10
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Tessier R, Ribeiro-Parenti L, Bruneau O, Khodorova N, Cavin JB, Bado A, Azzout-Marniche D, Calvez J, Le Gall M, Gaudichon C. Effect of different bariatric surgeries on dietary protein bioavailability in rats. Am J Physiol Gastrointest Liver Physiol 2019; 317:G592-G601. [PMID: 31460792 DOI: 10.1152/ajpgi.00142.2019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Bariatric surgery may induce protein malabsorption, although data are scarce. This study aims at evaluating dietary protein bioavailability after different bariatric surgeries in rats. Diet-induced obese Wistar rats were operated for vertical sleeve gastrectomy (VSG) or Roux-en-Y gastric bypass (RYGB). The control group was composed of pair-fed, sham-operated rats (Sham). Two weeks after surgery, rats were fed a 15N protein meal. Protein bioavailability was assessed by determination of 15N recovery in the gastrointestinal tract and organs 6 h after the meal. Fractional protein synthesis rate (FSR) was assessed using a flooding dose of 13C valine. Weight loss was the highest in RYGB rats and the lowest in Sham rats. Surprisingly, RYGB (95.6 ± 0.7%) improved protein digestibility (P = 0.045) compared with Sham (93.5 ± 0.5%) and VSG (93.8 ± 0.6%). In contrast, 15N retained in the liver (P = 0.001) and plasma protein (P = 0.037) was lower than in Sham, with a similar trend in muscle (P = 0.052). FSR was little altered by bariatric surgery, except for a decrease in the kidney of RYGB (P = 0.02). The 15N distribution along the small intestinal tissue suggests that dietary nitrogen was considerably retained in the remodeled mucosa of RYGB compared with Sham. This study revealed that in contrast to VSG, RYGB slightly improved protein digestibility but altered peripheral protein bioavailability. This effect may be ascribed to a higher uptake of dietary amino acids by the remodeled intestine.NEW & NOTEWORTHY Using a sensitive 15N meal test, we found that gastric bypass slightly improved protein digestibility compared with sleeve gastrectomy or control but, in contrast, lowered protein retention in the liver and muscles. This paradox can be due to a higher uptake of dietary nitrogen by the intestinal mucosa that was hypertrophied. This study provides new insight on the digestive and metabolic fate of dietary protein in different models of bariatric surgery in rats.
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Affiliation(s)
- Romain Tessier
- UMR Physiology of Nutrition and Ingestive Behavior (PNCA), AgroParisTech, INRA, Université Paris-Saclay, Paris, France.,INSERM UMRS 1149, UFR de Médecine Paris Diderot, Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Lara Ribeiro-Parenti
- INSERM UMRS 1149, UFR de Médecine Paris Diderot, Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France.,Department of General and Digestive Surgery, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ouafa Bruneau
- UMR Physiology of Nutrition and Ingestive Behavior (PNCA), AgroParisTech, INRA, Université Paris-Saclay, Paris, France.,INSERM UMRS 1149, UFR de Médecine Paris Diderot, Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nadezda Khodorova
- UMR Physiology of Nutrition and Ingestive Behavior (PNCA), AgroParisTech, INRA, Université Paris-Saclay, Paris, France
| | - Jean-Baptiste Cavin
- INSERM UMRS 1149, UFR de Médecine Paris Diderot, Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - André Bado
- INSERM UMRS 1149, UFR de Médecine Paris Diderot, Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Dalila Azzout-Marniche
- UMR Physiology of Nutrition and Ingestive Behavior (PNCA), AgroParisTech, INRA, Université Paris-Saclay, Paris, France
| | - Juliane Calvez
- UMR Physiology of Nutrition and Ingestive Behavior (PNCA), AgroParisTech, INRA, Université Paris-Saclay, Paris, France
| | - Maude Le Gall
- INSERM UMRS 1149, UFR de Médecine Paris Diderot, Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Claire Gaudichon
- UMR Physiology of Nutrition and Ingestive Behavior (PNCA), AgroParisTech, INRA, Université Paris-Saclay, Paris, France
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Vassilev G, Lammert A, Galata C, Seyfried S, Weiss C, Otto M. Myoglobin Determination After Bariatric Surgery Has No Additional Benefit. Bariatr Surg Pract Patient Care 2019. [DOI: 10.1089/bari.2018.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Georgi Vassilev
- Department of Surgery, Heidelberg University, University Medical Center Mannheim (UMM), Mannheim, Germany
| | - Alexander Lammert
- Department of Medical Statistics, Heidelberg University, University Medical Center Mannheim (UMM), Mannheim, Germany
| | - Christian Galata
- Department of Surgery, Heidelberg University, University Medical Center Mannheim (UMM), Mannheim, Germany
| | - Steffen Seyfried
- Department of Surgery, Heidelberg University, University Medical Center Mannheim (UMM), Mannheim, Germany
| | - Christel Weiss
- Department of Medical Statistics, Heidelberg University, University Medical Center Mannheim (UMM), Mannheim, Germany
| | - Mirko Otto
- Department of Surgery, Heidelberg University, University Medical Center Mannheim (UMM), Mannheim, Germany
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Ben-Porat T, Weiss-Sadan A, Rottenstreich A, Sherf-Dagan S, Schweiger C, Yosef-Levi IM, Weiner D, Azulay O, Sakran N, Harari R, Elazary R. Nutritional Management for Chronic Kidney Disease Patients who Undergo Bariatric Surgery: A Narrative Review. Adv Nutr 2019; 10:122-132. [PMID: 30753268 PMCID: PMC6370259 DOI: 10.1093/advances/nmy112] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 10/19/2018] [Accepted: 11/12/2018] [Indexed: 12/14/2022] Open
Abstract
Bariatric surgery (BS) may be effective for chronic kidney disease (CKD) patients by reducing microalbuminuria and proteinuria, and by facilitating their meeting inclusion criteria for kidney transplantation. However, nutritional management for this population is complex and specific guidelines are scarce. A literature search was performed to create dietetic practice for these patients based on the most recent evidence. For the purposes of nutritional recommendations, we divided the patients into 2 subgroups: 1) patients with CKD and dialysis, and 2) patients after kidney transplantation. Before surgery, nutritional care includes nutritional status evaluation and adjusting doses of supplements to treat deficiencies and daily nutrient intake according to the dietary restrictions derived from kidney disease, including quantities of fluids, protein, phosphorus, potassium, and vitamins. After BS, these patients are at major risk for lean body mass loss, malnutrition and dehydration because of fluid restriction and diuretics. Postoperative nutritional recommendations should be carefully tailored according to CKD nutritional limitations and include specific considerations regarding protein, fluids, and supplementation, in particular calcium, vitamin A, and vitamin D. Nutritional management of CKD and kidney transplant patients undergoing BS is challenging and future studies are required to establish uniform high-level evidence-based guidelines.
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Affiliation(s)
- Tair Ben-Porat
- The Israeli Dietetic Association, Herzliya, Israel
- Department of Nutrition, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Anat Weiss-Sadan
- The Israeli Dietetic Association, Herzliya, Israel
- Department of Nutrition, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Amihai Rottenstreich
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Shiri Sherf-Dagan
- The Israeli Dietetic Association, Herzliya, Israel
- Department of Nutrition, Assuta Medical Center, Tel Aviv, Israel
| | - Chaya Schweiger
- The Israeli Dietetic Association, Herzliya, Israel
- Department of Nutrition, Rabin Medical Center, Petach Tiqva, Israel
| | - Irit Mor Yosef-Levi
- Nephrology and Hypertension Services, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Dana Weiner
- The Israeli Dietetic Association, Herzliya, Israel
- Department of Nutrition, Sheba Medical Center, Tel Aviv, Israel
| | - Odile Azulay
- The Israeli Dietetic Association, Herzliya, Israel
- Department of Nutrition, Rabin Medical Center, Petach Tiqva, Israel
| | - Nasser Sakran
- Department of Surgery A, Emek Medical Center, Afula, affiliated with Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Rivki Harari
- The Israeli Dietetic Association, Herzliya, Israel
- Department of Nutrition, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ram Elazary
- Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Impact of Early Postbariatric Surgery Acute Kidney Injury on Long-Term Renal Function. Obes Surg 2018; 28:3580-3585. [DOI: 10.1007/s11695-018-3398-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Abstract
PURPOSE OF REVIEW Obesity rates in the USA have reached pandemic levels with one third of the population with obesity in 2015-2016 (39.8% of adults and 18.5% of youth). It is a major public health concern, and it is prudent to understand the factors which contribute. Racial and ethnic disparities are pronounced in both the prevalence and treatment of obesity and must be addressed in the efforts to combat obesity. RECENT FINDINGS Disparities in prevalence of obesity in racial/ethnic minorities are apparent as early as the preschool years and factors including genetics, diet, physical activity, psychological factors, stress, income, and discrimination, among others, must be taken into consideration. A multidisciplinary team optimizes lifestyle and behavioral interventions, pharmacologic therapy, and access to bariatric surgery to develop the most beneficial and equitable treatment plans. The reviewed studies outline disparities that exist and the impact that race/ethnicity have on disease prevalence and treatment response. Higher prevalence and reduced treatment response to lifestyle, behavior, pharmacotherapy, and surgery, are observed in racial and ethnic minorities. Increased research, diagnosis, and access to treatment in the pediatric and adult populations of racial and ethnic minorities are proposed to combat the burgeoning obesity epidemic and to prevent increasing disparity.
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Affiliation(s)
- Angel S Byrd
- Department of Dermatology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alexander T Toth
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Fatima Cody Stanford
- Harvard Medical School, Boston, MA, USA.
- MGH Weight Center, Gastrointestinal Unit-Department of Medicine, Massachusetts General Hospital, 50 Staniford Street, Suite 430, Boston, MA, 02114, USA.
- Department of Pediatrics-Endocrinology, Massachusetts General Hospital, Boston, MA, USA.
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Koppe U, Nitsch D, Mansfield KE, Mathur R, Bhaskaran K, Batterham RL, Smeeth L, Douglas IJ. Long-term effects of bariatric surgery on acute kidney injury: a propensity-matched cohort in the UK Clinical Practice Research Datalink. BMJ Open 2018; 8:e020371. [PMID: 29769254 PMCID: PMC5961582 DOI: 10.1136/bmjopen-2017-020371] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 04/17/2018] [Accepted: 04/19/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Bariatric surgery is an effective method of weight reduction and has been associated with acute kidney injury (AKI) as a perioperative event. However, the long-term effects of the weight reduction after surgery on AKI are unknown. The objective of this study is to quantify the association of bariatric surgery with later risk of AKI. DESIGN This study uses a propensity score-matched cohort of patients from the UK Clinical Practice Research Datalink database with and without bariatric surgery to compare rates of AKI episodes derived from linkage to the Hospital Episode Statistics. SETTING England, UK. PARTICIPANTS We included 2643 patients with bariatric surgery and 2595 patients without. RESULTS Results were compatible with an increased risk of AKI in the first 30 days following surgery compared with patients without surgery, but AKI incidence was substantially decreased in patients with bariatric surgery during long-term follow-up (rate ratio 0.37, 95% CI 0.23 to 0.61) even after accounting for chronic kidney disease status at baseline. Over the whole period of follow-up, bariatric surgery had a net protective effect on risk of AKI (rate ratio 0.45, 95% CI 0.28 to 0.72). CONCLUSIONS Bariatric surgery was associated with protective effects on AKI incidence during long-term follow-up. While the risk of AKI may be increased within the first 30 days, the net effect seen was beneficial.
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Affiliation(s)
- Uwe Koppe
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Dorothea Nitsch
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Royal Free London NHS Trust, London, UK
| | - Kathryn E Mansfield
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Rohini Mathur
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Krishnan Bhaskaran
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Rachel L Batterham
- Centre for Obesity Research, Rayne Institute, Department of Medicine, University College London, London, UK
- University College London Hospital Bariatric Centre for Weight Management and Metabolic Surgery, London, UK
- National Institute of Health Research, University College London Hospital Biomedical Research Centre, London, UK
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Ian J Douglas
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Roux-En-Y Gastric Bypass Vs. Sleeve Gastrectomy: Balancing the Risks of Surgery with the Benefits of Weight Loss. Obes Surg 2017; 27:154-161. [PMID: 27342739 PMCID: PMC5187368 DOI: 10.1007/s11695-016-2265-2] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background The purpose of the study was to compare weight loss, metabolic parameters, and postoperative complications in patients undergoing Roux-en-Y gastric bypass (GB) and sleeve gastrectomy (SG). Methods We retrospectively studied 30-day postoperative complications as well as change in weight, blood pressure, cholesterol, hemoglobin, hemoglobin A1C, and creatinine from baseline to 2, 6, 12, and 24 months postoperatively in 383 patients undergoing GB and 336 patients undergoing SG at the University of Michigan from January 2008 to November 2013. For a study population which typically has high attrition rates, there were excellent follow-up rates (706/719 at 2 months, 566/719 at 6 months, 519/719 at 12 months, and 382/719 at 24 months). Results Baseline characteristics were similar in both groups except for higher weight and BMI in the SG group. The GB group experienced greater total body weight loss at 6, 12, and 24 months (41.9 vs. 34.6 kg at 24 months, p < 0.0001). Excess weight loss was 69.7 and 51.7 % following GB and SG respectively at 24 months (p < 0.0001). BP improved significantly in both groups. Surgical complication rates were greater after GB (10.1 vs. 3.5 %, p = 0.0007) with no significant difference in life-threatening or potentially life-threatening complications. Conclusions Weight loss was greater following GB compared to SG at 2 years. The risk for surgical complications was greater following GB. Surgical intervention should be tailored to surgical risk, comorbidities, and desired weight loss. Electronic supplementary material The online version of this article (doi:10.1007/s11695-016-2265-2) contains supplementary material, which is available to authorized users.
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Predictors of Perioperative Acute Kidney Injury in Obese Patients Undergoing Laparoscopic Bariatric Surgery: a Single-Centre Retrospective Cohort Study. Obes Surg 2017; 26:1493-9. [PMID: 26482165 DOI: 10.1007/s11695-015-1938-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Obesity has been associated with increased risk of perioperative acute kidney injury (AKI). We aim to establish the incidence of AKI among patients undergoing laparoscopic bariatric surgery and identify potential risk factors. METHODS Records of 1230 patients who underwent laparoscopic bariatric surgery in a tertiary centre from 1 December 2009 to 31 January 2014 were retrospectively studied. AKI diagnosis was made by comparing the baseline and post-operative serum creatinine to determine the presence of predefined significant change based on the Kidney Disease: Improving Global Outcomes (KDIGO) definition. Univariate analyses were performed to determine significant clinical factors, and multiple logistic regression analysis was subsequently done to determine independent predictors of AKI. RESULTS Thirty-five (2.9 %) patients developed AKI during the first 72 h post-surgery. Multivariate logistic regression analysis revealed impaired renal function (OR 10.429, 95 % CI 3.560 to 30.552), use of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers (OR 3.038, 95 % CI 1.352 to 6.824), and body mass index (OR 1.048, 95 % CI 1.005 to 1.093) as independent predictors of perioperative acute kidney injury in the obese patients who underwent laparoscopic bariatric surgery. CONCLUSIONS We found that the incidence of perioperative AKI among patients who underwent laparoscopic bariatric surgery is at 2.9 %. Impaired renal function, use of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers and raised body mass index were found to be independent predictors of AKI. Patients with these risk factors could be considered at risk for developing perioperative AKI, and extra perioperative vigilance should be undertaken.
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Bariatric surgery is associated with renal function improvement. Surg Endosc 2017; 32:276-281. [PMID: 28664440 DOI: 10.1007/s00464-017-5674-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 06/16/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Weight loss after bariatric surgery improves both blood pressure and glycemic control following surgery. The effect of bariatric surgery on renal function is not well characterized. In this study, we sought to quantify the change in renal function over time following surgery. METHODS We retrospectively reviewed all patients who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) between 2012 and 2014 at our institution. The glomerular filtration rate (GFR, mL/min) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Body mass index (BMI, kg/m2) and percent weight loss (%WL) were calculated following the surgery. RESULTS A total of 149 patients who underwent bariatric surgery were included in this study: LRYGB (n = 86 and LSG (n = 63). In LRYGB group, baseline BMI (kg/m2, ±SD) and GFR (mL/min, ±SD) were 48.5 ± 6.8 and 94.7 ± 23.8, respectively. In comparison, BMI and GFR were 49.1 ± 11.9 kg/m2 and 93.1 ± 28.0 mL/min in the LSG group, respectively. Over the follow-up period (19.89 ± 10.93 months), the patients who underwent LRGYB lost a larger percentage of weight as compared to those in the LSG group (29.9 ± 11.7% vs 22.3 ± 10.7%; p = <0.0001). Overall, GFR improved in both LRYGB (101.0 ± 25.8 mL/min) and LSG groups (97.9 ± 25.8 mL/min) and was not significantly different between the two groups. Of patients with a GFR < 90 mL/min prior to weight loss surgery (n = 62), 42% had improvement of their GFR to > 90 mL/min postoperatively (p < 0.001). There was no relationship between weight loss percentage and GFR improvement (p = 0.8703). CONCLUSIONS Bariatric surgery was associated with improvement in postoperative renal function at almost two years following surgery but was not different for LRYGB versus LSG. The gain in GFR was independent of percentage of weight lost suggesting an alternate mechanism in the improvement of renal function other than weight loss alone.
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Gazzetta P, Bissolati M, Saibene A, Ghidini C, Guarneri G, Giannone F, Adamenko O, Secchi A, Rosati R, Socci C. Bariatric Surgery to Target Obesity in the Renal Transplant Population: Preliminary Experience in a Single Center. Transplant Proc 2017; 49:646-649. [DOI: 10.1016/j.transproceed.2017.02.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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20
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Coupaye M, Flamant M, Sami O, Calabrese D, Msika S, Bogard C, Vidal-Petiot E, Ledoux S. Determinants of Evolution of Glomerular Filtration Rate After Bariatric Surgery: a 1-Year Observational Study. Obes Surg 2016; 27:126-133. [PMID: 27312348 DOI: 10.1007/s11695-016-2260-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Mozer AB, Pender JR, Chapman WHH, Sippey ME, Pories WJ, Spaniolas K. Bariatric Surgery in Patients with Dialysis-Dependent Renal Failure. Obes Surg 2016; 25:2088-92. [PMID: 25832986 DOI: 10.1007/s11695-015-1656-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Laparoscopic procedures for the treatment of morbid obesity are commonly offered to patients with comorbidities previously thought to carry prohibitive operative risk. In this study, we reviewed characteristics and perioperative outcomes of patients with dialysis-dependent renal failure (DDRF) who underwent laparoscopic bariatric procedures. METHODS The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2006 to 2011 was reviewed. Preoperative characteristics and 30-day outcome data of patients who underwent three common laparoscopic procedures were analyzed using ANOVA and Pearson chi-squared tests. RESULTS One hundred thirty-eight patients (52.5 % female) with DDRF and a median body mass index (BMI) of 45.5 kg/m(2) were identified; 33.8 % (n = 47) underwent laparoscopic banding (LAGB), 48.9 % (n = 68) laparoscopic Roux-en-Y gastric bypass (RYGB), and 16.5 % (n = 23) laparoscopic sleeve gastrectomy (LSG). No differences were found among groups in age, prevalence of American Society of Anesthesiology IV classification, BMI, weight, gender, prevalence of diabetes, and vascular or neurologic comorbidities. Total operation time and length of hospital stay were significantly different between groups. Mortality was 0.7 %, and overall morbidity was 5.8 %. The case mix reflected a decrease in LAGB procedures from 45.5 to 23.3 % from 2006-2009 to 2010-2011 and an increase in LSG procedures from 9.1 to 24.7 % (p < 0.006). CONCLUSIONS When performed in selected DDRF patients, bariatric surgery is safe. An increase in LSG with a concurrent decline in LAGB procedures was demonstrated over the period of the study.
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Affiliation(s)
- Anthony B Mozer
- Department of Surgery, The Brody School of Medicine at East Carolina University, Greenville, NC, USA.
| | - John R Pender
- Department of Surgery, The Brody School of Medicine at East Carolina University, Greenville, NC, USA. .,Division of Advanced Laparoscopic, Gastrointestinal and Endocrine Surgery, East Carolina University Brody School of Medicine, 600 Moye Boulevard, Greenville, NC, 27834, USA.
| | - William H H Chapman
- Department of Surgery, The Brody School of Medicine at East Carolina University, Greenville, NC, USA. .,Division of Advanced Laparoscopic, Gastrointestinal and Endocrine Surgery, East Carolina University Brody School of Medicine, 600 Moye Boulevard, Greenville, NC, 27834, USA.
| | - Megan E Sippey
- Department of Surgery, The Brody School of Medicine at East Carolina University, Greenville, NC, USA.
| | - Walter J Pories
- Department of Surgery, The Brody School of Medicine at East Carolina University, Greenville, NC, USA. .,Division of Advanced Laparoscopic, Gastrointestinal and Endocrine Surgery, East Carolina University Brody School of Medicine, 600 Moye Boulevard, Greenville, NC, 27834, USA.
| | - Konstantinos Spaniolas
- Department of Surgery, The Brody School of Medicine at East Carolina University, Greenville, NC, USA. .,Division of Advanced Laparoscopic, Gastrointestinal and Endocrine Surgery, East Carolina University Brody School of Medicine, 600 Moye Boulevard, Greenville, NC, 27834, USA.
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Thongprayoon C, Cheungpasitporn W, Vijayvargiya P, Anthanont P, Erickson SB. The risk of kidney stones following bariatric surgery: a systematic review and meta-analysis. Ren Fail 2016; 38:424-30. [DOI: 10.3109/0886022x.2015.1137186] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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Chan G, Garneau P, Hajjar R. The impact and treatment of obesity in kidney transplant candidates and recipients. Can J Kidney Health Dis 2015; 2:26. [PMID: 26236496 PMCID: PMC4522095 DOI: 10.1186/s40697-015-0059-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 06/19/2015] [Indexed: 12/21/2022] Open
Abstract
The prevalence of obesity in patients with chronic kidney failure and renal transplant candidates has paralleled the epidemic in the general population. The associated risks of surgical complications and long-term cardiovascular death are significant: most transplant centers consider obesity a relative contra-indication for transplant. Few studies have focused on conservative weight loss strategies in transplant patients. Studies using administrative databases have found that only a minority of wait-listed patients lose weight and with no apparent benefit to transplant outcomes. The only clinical trial in this area found that an intensive weight-loss program had significantly better success (to listing) than self-directed weight loss. However, only a minority that succeeded with the help of a program (36 %), while the “diet and exercise” group had negligible results. Laparoscopy has radically shortened the recovery time and decreased the complications associated with bariatric surgery. Reports in transplant patients, who were previously deemed too medically complex, have demonstrated a dramatic and rapid weight loss. The only randomized clinical trial in patients with CKD, which compared sleeve gastrectomy to best medical care clearly favoured the surgical arm for weight loss, but was too small to assess other outcomes. The emerging experience is small but quite promising. Surgical complications and the effect on immunosuppression remain the chief concerns regarding the use of bariatric surgery in transplant patients. Rigorous prospective studies will be essential to properly evaluate the expected weight loss and the effect on pharmacokinetics of immunosuppressive medications. A routine role for bariatric surgery in transplantation would require evidence of improvements in patient-important outcomes and evidence of safety.
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Affiliation(s)
- Gabriel Chan
- Département de Chirurgie, Université de Montréal and Service de Transplantation Rénale, Hôpital Maisonneuve-Rosemont, Montreal, Canada
| | - Pierre Garneau
- Département de Chirurgie, Université de Montréal, Hôpital Sacre-Cœur de Montréal, Montreal, Canada
| | - Roy Hajjar
- Département de Chirurgie, Université de Montréal and Service de Transplantation Rénale, Hôpital Maisonneuve-Rosemont, Montreal, Canada
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Serra A, Esteve A, Navarro-Díaz M, López D, Bancu I, Romero R. Long-Term Normal Renal Function after Drastic Weight Reduction in Patients with Obesity-Related Glomerulopathy. Obes Facts 2015; 8:188-99. [PMID: 25968610 PMCID: PMC5644892 DOI: 10.1159/000431027] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 01/08/2015] [Indexed: 12/13/2022] Open
Abstract
AIMS No long-term studies of renal function evolution in morbidly obese (MO) patients after weight loss are available. The aim of our work was to ascertain the long-term influence of drastic weight reduction on renal function in MO patients with obesity-related glomerular lesions. METHODS 92 MO patients with normal renal function and biopsy evidence of mild obesity-related glomerulopathy underwent bariatric surgery (BS) and subsequent drastic weight loss. A long-term prospective follow-up (mean duration: 76 ± 42 months) was carried out. Basal renal biopsies and basal and long-term metabolic and renal function studies were performed in all cases. Linear mixed models were applied. RESULTS Blood pressure dropped early after BS and remained stable thereafter. Creatinine clearance and BMI fell in the first 2 years, rose slightly after 5 years and then remained stable. Serum creatinine and albuminuria decreased throughout the follow-up period. Renal function and albuminuria evolution showed non-significant differences in relation to the number of glomerular lesions. CONCLUSIONS Drastic weight loss in BS-treated MO patients with pre-surgical normal renal function and mild obesity-related glomerular lesions is associated with short- and long-term maintenance of normal renal function and improvement in both arterial hypertension and albuminuria.
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Affiliation(s)
- Assumpta Serra
- Department of Nephrology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Anna Esteve
- Department of CEESCAT, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Maruja Navarro-Díaz
- Department of Nephrology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Dolores López
- Department of Pathology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Ioana Bancu
- Department of Nephrology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Ramón Romero
- Department of Nephrology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
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Saleh F, Kim SJ, Okrainec A, Jackson TD. Bariatric surgery in patients with reduced kidney function: an analysis of short-term outcomes. Surg Obes Relat Dis 2014; 11:828-35. [PMID: 25868831 DOI: 10.1016/j.soard.2014.11.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 11/10/2014] [Accepted: 11/10/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND With rates of obesity among patients with chronic kidney disease (CKD) mirroring that of the general population, there is growing interest in offering bariatric surgery to these patients. We sought to determine the safety of bariatric surgery in this patient population. METHODS Patients who underwent selected laparoscopic bariatric procedures between 2005 and 2011. Estimated glomerular filtration rate (eGFR) was calculated and divided into stages of CKD. Procedures included Roux-en-Y gastric bypass (RYGB), laparoscopic adjustable gastric band (LAGB), and laparoscopic sleeve gastrectomy (SG). Univariable analysis and multivariable adjustment was used to compare complication rates across stages of eGFR. RESULTS A total of 64,589 patients were included: 64.5% underwent RYGB, 29.8% LAGB, and 5.7% SG. A total of 61.7% of patients had normal eGFR (Stage 1), 32.0% were stage 2, 5.3% were stage 3, and 1.0% were stage 4/5. After adjusting for relevant patient characteristics, there was a trend toward increasing complications from stage 1 to stage 4/5 CKD among RYGB, LAGB, and SG groups, but none were statistically significant. Similarly, major complications generally increased across stages of CKD for each procedure, but was only significant for RYGB comparing stage 3 to stage 1 (OR 1.22; 95% CI: 1.01-1.47; P = .042) and risk difference .96% (95% CI: .03-1.96). Considering only stage 4/5 CKD, overall (P = .114) and major complications (P = .032) were highest in the RYGB group, followed by SG and LAGB. CONCLUSION More advanced stages of CKD do not appear to be statistically associated with an increased risk of 30-day postoperative complications.
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Affiliation(s)
- Fady Saleh
- Division of General Surgery, University Health Network, Toronto, Ontario, Canada
| | - S Joseph Kim
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Allan Okrainec
- Division of General Surgery, University Health Network, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Timothy D Jackson
- Division of General Surgery, University Health Network, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
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Felizardo RJF, Silva MBD, Aguiar CF, Câmara NOS. Obesity in kidney disease: A heavyweight opponent. World J Nephrol 2014; 3:50-63. [PMID: 25332896 PMCID: PMC4202492 DOI: 10.5527/wjn.v3.i3.50] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 04/18/2014] [Accepted: 06/11/2014] [Indexed: 02/05/2023] Open
Abstract
Obesity is an important worldwide challenge that must be faced in most developed and developing countries because of unhealthy nutritional habits. The consequences of obesity and being overweight are observed in different organs, but the kidney is one of the most affected. Excess adipose tissue causes hemodynamic alterations in the kidney that can result in renal disease. However, obesity is also commonly associated with other comorbidities such as chronic inflammation, hypertension and diabetes. This association of several aggravating factors is still a matter of concern in clinical and basic research because the pathophysiologic mechanisms surrounding chronic kidney disease development in obese patients remain unclear. This review will discuss the consequences of obesity in the context of renal injury.
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DiCecco SR, Francisco-Ziller N. Obesity and organ transplantation: successes, failures, and opportunities. Nutr Clin Pract 2014; 29:171-91. [PMID: 24503157 DOI: 10.1177/0884533613518585] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The increasing rate of societal obesity is also affecting the transplant world through obesity in candidates and donors as well as its posttransplant repercussions. Being overweight and obese has been shown to have significant effects on both short- and long-term complications as well as patient and graft survival. However, much of the comorbidity can be controlled or prevented with careful patient selection and aggressive management. A team approach to managing obesity and its comorbidities both pre- and posttransplant is essential for successful transplant outcomes. Complicating understanding the results of obesity research is the inclusion different weight categories, use of listing vs transplant weights, patient populations large enough for statistical power, and changes in transplant management, especially immunosuppression protocols, anti-infection protocols, and operative techniques. Much more research is needed regarding many elements, including safe weight loss before transplantation, prevention of weight gain after transplant, genomic influences, and the role of bariatric surgery in the transplant process.
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Affiliation(s)
- Sara R DiCecco
- Sara R. DiCecco, Mayo Clinic Hospital-Rochester Methodist Campus, 201 West Center Street, Rochester, MN 55902, USA.
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Imam TH, Wang J, Khayat FS. Bariatric surgery in a patient on peritoneal dialysis. Perit Dial Int 2013; 33:710-1. [PMID: 24335131 DOI: 10.3747/pdi.2012.00272] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- T H Imam
- Division of Nephrology1 Southern California Permanente Medical Group Kaiser Permanente Fontana Medical Center Fontana, California, USA Division of Surgery2 Northern California Permanente Medical Group San Francisco, California, USA
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Stephenson DT, Jandeleit-Dahm K, Balkau B, Cohen N. Improvement in albuminuria in patients with type 2 diabetes after laparoscopic adjustable gastric banding. Diab Vasc Dis Res 2013; 10:514-9. [PMID: 23975723 DOI: 10.1177/1479164113498083] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To determine the effects of laparoscopic adjustable gastric banding (LAGB) on albuminuria in patients with obesity, type 2 diabetes mellitus (T2DM) and established diabetic nephropathy. METHODS A retrospective analysis of clinical records from a tertiary diabetes service identified obese patients with T2DM who had micro- or macroalbuminuria prior to LAGB surgery. Clinical data from follow-up appointments including albuminuria were analysed. RESULTS A total of 23 T2DM patients were included in the final study. Of 7 patients with macroalbuminuria at baseline, 2 reverted to normoalbuminuria, 2 reverted to microalbuminuria and 3 remained with macroalbuminuria on their final recording in the 36-month period of follow-up. Of 16 patients with microalbuminuria, 9 reverted to normoalbuminuria, while 6 remained with microalbuminuria. CONCLUSION This study demonstrates significant improvements in albuminuria in patients with established diabetic nephropathy following LAGB. These results suggest the potential for LAGB to improve or reverse renal damage in patients with T2DM.
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Hou CC, Shyu RS, Lee WJ, Ser KH, Lee YC, Chen SC. Improved renal function 12 months after bariatric surgery. Surg Obes Relat Dis 2013; 9:202-6. [DOI: 10.1016/j.soard.2012.10.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 10/10/2012] [Accepted: 10/11/2012] [Indexed: 01/03/2023]
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Troxell ML, Houghton DC, Hawkey M, Batiuk TD, Bennett WM. Enteric oxalate nephropathy in the renal allograft: an underrecognized complication of bariatric surgery. Am J Transplant 2013; 13:501-9. [PMID: 23311979 DOI: 10.1111/ajt.12029] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 10/18/2012] [Accepted: 10/31/2012] [Indexed: 02/06/2023]
Abstract
Enteric hyperoxalosis is a recognized complication of bariatric surgery, with consequent oxalate nephropathy leading to chronic kidney disease and occasionally end-stage renal failure. In patients with prior gastrointestinal bypass surgery, renal allografts are also at risk of oxalate nephropathy. Further, transplant recipients may be exposed to additional causes of hyperoxalosis. We report two cases of renal allograft oxalate nephropathy in patients with remote histories of bariatric surgery. Conservative management led to improvement of graft function in one patient, while the other patient returned to dialysis. Interpretation of serologic, urine and biopsy studies is complicated by oxalate accumulation in chronic renal failure, and heightened excretion in the early posttransplant period. A high index of suspicion and careful clinicopathologic correlation on the part of transplant nephrologists and renal pathologists are required to recognize and treat allograft oxalate nephropathy. As the incidence of obesity and pretransplant bariatric surgery increases in the transplant population, allograft oxalate nephropathy is likely to be an increasing cause of allograft dysfunction.
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Affiliation(s)
- M L Troxell
- Department of Pathology, Oregon Health & Science University, Portland, OR, USA.
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Harcourt BE, Penfold SA, Forbes JM. Coming full circle in diabetes mellitus: from complications to initiation. Nat Rev Endocrinol 2013; 9:113-23. [PMID: 23296171 DOI: 10.1038/nrendo.2012.236] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Glycaemic control, reduction of blood pressure using agents that block the renin-angiotensin system and control of dyslipidaemia are the major strategies used in the clinical management of patients with diabetes mellitus. Each of these approaches interrupts a number of pathological pathways, which directly contributes to the vascular complications of diabetes mellitus, including renal disease, blindness, neuropathy and cardiovascular disease. However, research published over the past few years has indicated that many of the pathological pathways important in the development of the vascular complications of diabetes mellitus are equally relevant to the initiation of diabetes mellitus itself. These pathways include insulin signalling, generation of cellular energy, post-translational modifications and redox imbalances. This Review will examine how the development of diabetes mellitus has come full circle from initiation to complications and suggests that the development of diabetes mellitus and the progression to chronic complications both require the same mechanistic triggers.
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Affiliation(s)
- Brooke E Harcourt
- Glycation and Diabetes Complications, Mater Medical Research Institute, Raymond Terrace, South Brisbane, QLD, Australia
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Ritz E. Bariatric surgery and the kidney-much benefit, but also potential harm. Clin Kidney J 2012; 6:368-72. [PMID: 27293562 PMCID: PMC4898330 DOI: 10.1093/ckj/sfs161] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 10/19/2012] [Indexed: 12/14/2022] Open
Abstract
Bariatric surgery is increasingly performed on overweight individuals. A significant benefit with respect to cardiovascular (CV) events and survival has been documented. After weight loss, reduction of albuminuria/proteinuria is almost consistently seen; small studies documented retardation of the glomerular filtration rate (GFR) loss after bariatric surgery; reduction of blood pressure (BP) is less consistent. It has been known for a long time that the frequency of oxalate stones is increased after bariatric surgery. The main renal threat of hyperoxaluria is renal oxalosis, often irreversible, causing persisting renal failure. The causes are reduced oxalate binding by calcium due to saponification of calcium causing fat malabsorption, increased permeability for oxalate because of increased permeability of colon mucosa triggered by increased bile salts and reduced colonization of the colon by oxalobacter formigenes. These mechanisms are susceptible to treatment.
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Affiliation(s)
- Eberhard Ritz
- Nierenzentrum , University of Heidelberg , Heidelberg , Germany
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Getty JLZ, Hamdallah IN, Shamseddeen HN, Wu J, Low RK, Craig J, Ali MR. Changes in renal function following Roux-en-Y gastric bypass: a prospective study. Obes Surg 2012; 22:1055-9. [PMID: 22318447 DOI: 10.1007/s11695-012-0617-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Studies of the impact of Roux-en-Y gastric bypass (RYGB) on renal function have shown mixed results. We constructed this prospective repeated-measures controlled study to characterize this response and identify the best method of gauging renal function in this setting. METHODS Clinical data, serum creatinine (SC), and 24-h urine were collected 1 week before and 6 months following RYGB. Glomerular filtration rate (GFR) was calculated utilizing the Modification of Diet in Renal Disease formula. Creatinine clearance (CCL) was measured as a 24-h collection (24 CCL) and calculated by the Cockcroft-Gault (CG) formula. RESULTS The study population of 37 patients (81% women) had a mean age of 47 ± 11 years, had mean BMI of 47.6 ± 6.3 kg/m(2), and achieved a mean % excess weight loss (EWL) of 60.9 ± 17.1%. SC decreased from 0.83 ± 0.21 mg/dl to 0.72 ± 0.16 mg/dl (p < 0.001) and mean GFR improved from 91.6 ± 29.7 ml/min/1.73 m(2) to 104.9 ± 23.5 ml/min/1.73 m(2) (p < 0.01). Preoperatively, CG significantly overestimated CCL when compared with 24 CCL (197.1 ± 88.2 ml/min vs. 136.5 ± 53.0 ml/min, p < 0.001). In all patients, improvement in 24 CCL correlated with EWL (r = 0.32) and %EWL (r = 0.16), and significantly correlated with decrease in BMI (r = 0.51, p < 0.005). In hypertensive patients, improvement in 24 CCL significantly correlated with EWL (r = 0.43, p < 0.05), %EWL (r = 0.40, p < 0.05), and decrease in BMI (r = 0.60, p < 0.001) and was negatively correlated with age (r = -0.45, p < 0.05). CONCLUSIONS This study demonstrates that renal function improves following RYGB and is best identified by change in GFR. Improvement in 24 CCL is correlated with the EWL success of the patient, especially hypertensive patients.
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Affiliation(s)
- Jorge L Zelada Getty
- Department of Surgery, University of California, Davis, 2221 Stockton Boulevard, Cypress Building, Sacramento, CA 95817, USA
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Abstract
Obesity is a worldwide epidemic leading to severe comorbidity that damages end-organ function. Overall transplant outcomes in this population are inferior to those in nonobese patients. Large population studies show decreased patient and graft survival in obese kidney transplant patients. Despite the poorer outcomes, kidney transplantation is considered because of the survival benefit as compared with the wait-listed dialysis patients. In liver transplantation, the benefit to transplantation as compared with remaining on the list is obvious, as there is no viable liver dialysis at this time. Obesity in potential organ donors impacts both medical and surgical issues. Obesity-related kidney disease affects both the remaining and transplanted kidney. Pancreas donor organs are associated with decreased early graft survival. Liver donor organs with significant steatosis lead to an increased risk for delayed or nonfunction of the organ. Immunosuppressive drugs with variable lipophilicity and altered volume of distribution can greatly affect the therapeutic usefulness of these drugs. Transplant candidates benefit from a multidisciplinary team approach to their care. As the epidemic progresses and less-invasive treatments for metabolic surgery evolve, we are likely to require more patients to lose weight prior to transplantation as we continue to strive for improved outcomes.
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Blackburn GL, Magerowski G. The Impact of Renal Function on Outcomes of Bariatric Surgery. J Am Soc Nephrol 2012; 23:769-70. [DOI: 10.1681/asn.2012030306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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GFR estimation in the morbidly obese pre- and postbariatric surgery: one size does not fit all. Int Urol Nephrol 2012; 45:157-62. [DOI: 10.1007/s11255-012-0131-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 01/17/2012] [Indexed: 11/27/2022]
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Interpreting different measures of glomerular filtration rate in obesity and weight loss: pitfalls for the clinician. Int J Obes (Lond) 2011; 36:1421-7. [PMID: 22184061 DOI: 10.1038/ijo.2011.242] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
To combat the increasing incidence of obesity, much research has been devoted to devising successful strategies for weight loss, including manipulation of diet and gastric surgery. Obesity itself can be associated with renal dysfunction, and the degree of reversibility of this with weight loss has being studied. However, there are significant limitations and flaws in the methods we have available to measure glomerular filtration rate (GFR) in overweight and obese subjects. Obesity is associated with changes in body composition including lean and fat mass. This has implications for assumptions that underpin creatinine-based measures such as creatinine clearance, estimated GFR and other equations devised for obesity including the Salazar-Corcoran equation. These changes in body composition also affect measures of glomerular filtration such as cystatin C and nuclear medicine isotope scans. This article will review the accuracy of these current measures of renal function in the obese and consider the evidence for adjusting for body surface area or adjusting for lean body mass. Finally, the effect of weight loss itself on serial measurements of renal function in a given individual, independent of a true change in renal function, will be reviewed. Ultimately using the Cockcroft-Gault equation with an adjustment for lean body mass seems to be the best measure for renal function in obesity. No method for measuring renal function in situations of weight loss has been shown to be unequivocally superior.
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Abstract
Published data show that bariatric surgery not only leads to significant and sustained weight loss but also resolves or improves multiple comorbidities associated with morbid obesity. Evidence suggests that the earlier the intervention the better the resolution of comorbidities. Patients with metabolic syndrome and comorbidities associated with morbid obesity should be promptly referred for consideration for bariatric surgery earlier in the disease process.
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Affiliation(s)
- Ashutosh Kaul
- Department of Surgery, Westchester Medical Center, 100 Woods Road PMB 583, Valhalla, NY 10595, USA.
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