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Pereira MJ, Mathioudaki A, Otero AG, Duvvuri PP, Vranic M, Sedigh A, Eriksson JW, Svensson MK. Renal sinus adipose tissue: exploratory study of metabolic features and transcriptome compared with omental and subcutaneous adipose tissue. Obesity (Silver Spring) 2024. [PMID: 39210585 DOI: 10.1002/oby.24114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 06/18/2024] [Accepted: 06/18/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE The objective was to study metabolic characteristics and transcriptome of renal sinus adipose tissue (RSAT) located around renal arteries and veins. METHODS Adipose tissue biopsies from RSAT, omental (OAT), and subcutaneous (SAT) depots were obtained from healthy kidney donors (20 female, 20 male). Adipocyte glucose uptake rate and cell size were measured, and gene expression analyses using transcriptomics were performed. RESULTS RSAT adipocytes were significantly smaller, with a higher basal glucose uptake rate, than adipocytes from SAT and OAT. Transcriptomic analyses revealed 29 differentially expressed genes between RSAT and OAT (RSAT: 23 lower, 6 higher) and 1214 differentially expressed genes between RSAT and SAT (RSAT: 859 lower, 355 higher). RSAT demonstrated molecular resemblance to OAT, both exhibiting lower metabolic gene expression and higher expression of immune-related pathways, including IL-17, TNFα, and NF-κB signaling than SAT. Weighted gene coexpression network analysis associated RSAT with immune response and nucleic acid transport processes. Despite its location near the renal hilum, RSAT closely resembled OAT and there was a lack of expression in the classical brown adipose tissue genes. Gene enrichment analyses suggest an inflammatory environment in RSAT compared with SAT and, to some extent, OAT. CONCLUSIONS The findings suggest specific RSAT functions that could impact renal function and, possibly, the development of renal and cardiometabolic disorders.
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Affiliation(s)
- Maria J Pereira
- Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden
| | - Argyri Mathioudaki
- Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden
| | - Alicia G Otero
- Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden
| | - Padma Priya Duvvuri
- Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden
| | - Milica Vranic
- Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden
| | - Amir Sedigh
- Department of Surgical Sciences, Transplantation Surgery, Uppsala University, Uppsala, Sweden
| | - Jan W Eriksson
- Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden
| | - Maria K Svensson
- Department of Medical Sciences, Renal Medicine, Uppsala University, Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
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Jimba T, Kaneko H, Azegami T, Suzuki Y, Okada A, Ko T, Fujiu K, Takeda N, Morita H, Hayashi K, Nishiyama A, Node K, Yasunaga H, Takeda N, Nangaku M, Komuro I. Body weight change associated kidney outcomes of sodium-glucose cotransporter new users. Diabetes Obes Metab 2024. [PMID: 39072974 DOI: 10.1111/dom.15808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 06/30/2024] [Accepted: 07/01/2024] [Indexed: 07/30/2024]
Abstract
AIM To investigate the clinical significance of body weight changes on kidney outcomes among individuals with diabetes using sodium-glucose cotransporter-2 (SGLT2) inhibitors. MATERIALS AND METHODS This is a retrospective cohort study using a nationwide epidemiological database, and we conducted an analysis involving 11 569 individuals with diabetes who were newly prescribed SGLT2 inhibitors. The main outcome was the rate of decline in estimated glomerular filtration rate (eGFR), determined through a linear mixed-effects model with an unstructured covariance structure. RESULTS The median age of the patients was 52 (Q1-Q3: 47-58) years, and the median fasting plasma glucose and glycated haemoglobin (HbA1c) levels were 144 (Q1-Q3: 124-175) mg/dL and 7.4 (Q1-Q3: 6.8-8.3)%, respectively. The median estimated eGFR was 77.7 (Q1-Q3: 67.2-89.1) mL/min/1.73 m2. The median follow-up period was 1.7 (Q1-Q3: 1.0-2.6) years. Participants were stratified into three groups based on the body mass index change rate tertiles between baseline and 1 year after (tertile 1: <-4.55%, tertile 2: -4.55% to -1.43%, tertile 3: >-1.43%). The annual change in eGFR was -0.78 (-0.94 to -0.63) mL/min/1.73 m2 in tertile 1, -0.95 (-1.09 to -0.81) mL/min/1.73 m2 in tertile 2, and -1.65 mL/min/1.73 m2 (-1.84 to -1.47) in tertile 3 (pinteraction < 0.001). A variety of sensitivity analyses confirmed the relationship between the 1-year body mass index decrease and favourable kidney outcomes after SGLT2 inhibitor administration. CONCLUSIONS Our analysis of a nationwide epidemiological cohort revealed that kidney outcomes following the initiation of SGLT2 inhibitors would be more favourable, with greater body weight loss observed after the initiation of SGLT2 inhibitors.
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Affiliation(s)
- Takahiro Jimba
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Hidehiro Kaneko
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | - Tatsuhiko Azegami
- Division of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yuta Suzuki
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshiyuki Ko
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | - Norifumi Takeda
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Kaori Hayashi
- Division of Endocrinology, Metabolism, and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Akira Nishiyama
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Norihiko Takeda
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- Department of Frontier Cardiovascular Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- International University of Health and Welfare, Tokyo, Japan
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3
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Lin L, Pan X, Feng Y, Yang J. Chronic kidney disease combined with metabolic syndrome is a non-negligible risk factor. Ther Adv Endocrinol Metab 2024; 15:20420188241252309. [PMID: 39071115 PMCID: PMC11273817 DOI: 10.1177/20420188241252309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 04/10/2024] [Indexed: 07/30/2024] Open
Abstract
Metabolic syndrome (MetS) is a group of conditions characterized by hypertension (HTN), hyperglycaemia or insulin resistance (IR), hyperlipidaemia, and abdominal obesity. MetS is associated with a high incidence of cardiovascular events and mortality and is an independent risk factor for chronic kidney disease (CKD). MetS can cause CKD or accelerate the progression of kidney disease. Recent studies have found that MetS and kidney disease have a cause-and-effect relationship. Patients with CKD, those undergoing kidney transplantation, or kidney donors have a significantly higher risk of developing MetS than normal people. The present study reviewed the possible mechanisms of MetS in patients with CKD, including the disorders of glucose and fat metabolism after kidney injury, IR, HTN and the administration of glucocorticoid and calcineurin inhibitors. In addition, this study reviewed the effect of MetS in patients with CKD on important target organs such as the kidney, heart, brain and blood vessels, and the treatment and prevention of CKD combined with MetS. The study aims to provide strategies for the diagnosis, treatment and prevention of CKD in patients with MetS.
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Affiliation(s)
- Lirong Lin
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (General Hospital), Chongqing, China
| | - Xianfeng Pan
- Department of Nephrology, Chongqing Kaizhou District People’s Hospital of Chongqing, Chongqing, China
| | - Yuanjun Feng
- Department of Nephrology, Guizhou Aerospace Hospital, Guizhou 563000, China
| | - Jurong Yang
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (General Hospital), Chongqing 401120, China
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Subramanian A, Vernon KA, Zhou Y, Marshall JL, Alimova M, Arevalo C, Zhang F, Slyper M, Waldman J, Montesinos MS, Dionne D, Nguyen LT, Cuoco MS, Dubinsky D, Purnell J, Keller K, Sturner SH, Grinkevich E, Ghoshal A, Kotek A, Trivioli G, Richoz N, Humphrey MB, Darby IG, Miller SJ, Xu Y, Weins A, Chloe-Villani A, Chang SL, Kretzler M, Rosenblatt-Rosen O, Shaw JL, Zimmerman KA, Clatworthy MR, Regev A, Greka A. Protective role for kidney TREM2 high macrophages in obesity- and diabetes-induced kidney injury. Cell Rep 2024; 43:114253. [PMID: 38781074 PMCID: PMC11249042 DOI: 10.1016/j.celrep.2024.114253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/05/2024] [Accepted: 05/03/2024] [Indexed: 05/25/2024] Open
Abstract
Diabetic kidney disease (DKD), the most common cause of kidney failure, is a frequent complication of diabetes and obesity, and yet to date, treatments to halt its progression are lacking. We analyze kidney single-cell transcriptomic profiles from DKD patients and two DKD mouse models at multiple time points along disease progression-high-fat diet (HFD)-fed mice aged to 90-100 weeks and BTBR ob/ob mice (a genetic model)-and report an expanding population of macrophages with high expression of triggering receptor expressed on myeloid cells 2 (TREM2) in HFD-fed mice. TREM2high macrophages are enriched in obese and diabetic patients, in contrast to hypertensive patients or healthy controls in an independent validation cohort. Trem2 knockout mice on an HFD have worsening kidney filter damage and increased tubular epithelial cell injury, all signs of worsening DKD. Together, our studies suggest that strategies to enhance kidney TREM2high macrophages may provide therapeutic benefits for DKD.
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Affiliation(s)
- Ayshwarya Subramanian
- Klarman Cell Observatory, Broad Institute of MIT and Harvard, Cambridge, MA, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA.
| | | | - Yiming Zhou
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.
| | - Jamie L Marshall
- Broad Institute of MIT and Harvard, Cambridge, MA, USA; Kidney Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Maria Alimova
- Kidney Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Carlos Arevalo
- Broad Institute of MIT and Harvard, Cambridge, MA, USA; Kidney Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Fan Zhang
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Michal Slyper
- Klarman Cell Observatory, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Julia Waldman
- Klarman Cell Observatory, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | | | - Lan T Nguyen
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | - Dan Dubinsky
- Klarman Cell Observatory, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Jason Purnell
- Klarman Cell Observatory, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Keith Keller
- Kidney Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | - Elizabeth Grinkevich
- Kidney Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Ayan Ghoshal
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Amanda Kotek
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Giorgio Trivioli
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, Cambridge, UK; Nephrology Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Nathan Richoz
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Mary B Humphrey
- Department of Internal Medicine, Division of Nephrology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Isabella G Darby
- Department of Internal Medicine, Division of Nephrology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Sarah J Miller
- Department of Internal Medicine, Division of Nephrology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Yingping Xu
- Institute of Dermatology and Venereology, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Astrid Weins
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Steven L Chang
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA; Division of Urology, Brigham and Women's Hospital, Boston, MA, USA
| | - Matthias Kretzler
- Internal Medicine, Department of Nephrology, University of Michigan, Ann Arbor, MI, USA
| | | | - Jillian L Shaw
- Broad Institute of MIT and Harvard, Cambridge, MA, USA; Kidney Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Kurt A Zimmerman
- Department of Internal Medicine, Division of Nephrology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Menna R Clatworthy
- Molecular Immunity Unit, Department of Medicine, University of Cambridge, Cambridge, UK; Cellular Genetics, Wellcome Sanger Institute, Hinxton, UK; NIHR Cambridge Biomedical Research Center, Cambridge, UK; Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Cambridge, UK
| | - Aviv Regev
- Klarman Cell Observatory, Broad Institute of MIT and Harvard, Cambridge, MA, USA; Howard Hughes Medical Institute, Department of Biology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Anna Greka
- Broad Institute of MIT and Harvard, Cambridge, MA, USA; Kidney Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA; Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
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5
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Raphael H, Klang E, Konen E, Inbar Y, Leibowitz A, Frenkel-Nir Y, Apter S, Grossman E. Obesity Is Associated with Fatty Liver and Fat Changes in the Kidneys in Humans as Assessed by MRI. Nutrients 2024; 16:1387. [PMID: 38732633 PMCID: PMC11085048 DOI: 10.3390/nu16091387] [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: 04/05/2024] [Revised: 04/30/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Obesity is associated with metabolic syndrome and fat accumulation in various organs such as the liver and the kidneys. Our goal was to assess, using magnetic resonance imaging (MRI) Dual-Echo phase sequencing, the association between liver and kidney fat deposition and their relation to obesity. METHODS We analyzed MRI scans of individuals who were referred to the Chaim Sheba Medical Center between December 2017 and May 2020 to perform a study for any indication. For each individual, we retrieved from the computerized charts data on sex, and age, weight, height, body mass index (BMI), systolic and diastolic blood pressure (BP), and comorbidities (diabetes mellitus, hypertension, dyslipidemia). RESULTS We screened MRI studies of 399 subjects with a median age of 51 years, 52.4% of whom were women, and a median BMI 24.6 kg/m2. We diagnosed 18% of the participants with fatty liver and 18.6% with fat accumulation in the kidneys (fatty kidneys). Out of the 67 patients with fatty livers, 23 (34.3%) also had fatty kidneys, whereas among the 315 patients without fatty livers, only 48 patients (15.2%) had fatty kidneys (p < 0.01). In comparison to the patients who did not have a fatty liver or fatty kidneys (n = 267), those who had both (n = 23) were more obese, had higher systolic BP, and were more likely to have diabetes mellitus. In comparison to the patients without a fatty liver, those with fatty livers had an adjusted odds ratio of 2.91 (97.5% CI; 1.61-5.25) to have fatty kidneys. In total, 19.6% of the individuals were obese (BMI ≥ 30), and 26.1% had overweight (25 < BMI < 30). The obese and overweight individuals were older and more likely to have diabetes mellitus and hypertension and had higher rates of fatty livers and fatty kidneys. Fat deposition in both the liver and the kidneys was observed in 15.9% of the obese patients, in 8.3% of the overweight patients, and in none of those with normal weight. Obesity was the only risk factor for fatty kidneys and fatty livers, with an adjusted OR of 6.3 (97.5% CI 2.1-18.6). CONCLUSIONS Obesity is a major risk factor for developing a fatty liver and fatty kidneys. Individuals with a fatty liver are more likely to have fatty kidneys. MRI is an accurate modality for diagnosing fatty kidneys. Reviewing MRI scans of any indication should include assessment of fat fractions in the kidneys in addition to that of the liver.
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Affiliation(s)
- Hadar Raphael
- Arrow Projects for Medical Research Education, The Chaim Sheba Medical Center, Tel Hashomer 5266202, Israel;
- Department of Imaging, The Chaim Sheba Medical Center, Tel Hashomer 5266202, Israel; (E.K.); (E.K.); (Y.I.); (S.A.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 5266202, Israel; (A.L.); (Y.F.-N.)
| | - Eyal Klang
- Department of Imaging, The Chaim Sheba Medical Center, Tel Hashomer 5266202, Israel; (E.K.); (E.K.); (Y.I.); (S.A.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 5266202, Israel; (A.L.); (Y.F.-N.)
| | - Eli Konen
- Department of Imaging, The Chaim Sheba Medical Center, Tel Hashomer 5266202, Israel; (E.K.); (E.K.); (Y.I.); (S.A.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 5266202, Israel; (A.L.); (Y.F.-N.)
| | - Yael Inbar
- Department of Imaging, The Chaim Sheba Medical Center, Tel Hashomer 5266202, Israel; (E.K.); (E.K.); (Y.I.); (S.A.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 5266202, Israel; (A.L.); (Y.F.-N.)
| | - Avshalom Leibowitz
- Faculty of Medicine, Tel Aviv University, Tel Aviv 5266202, Israel; (A.L.); (Y.F.-N.)
- Internal Medicine D the Chaim Sheba Medical Center, Tel Hashomer 5266202, Israel
| | - Yael Frenkel-Nir
- Faculty of Medicine, Tel Aviv University, Tel Aviv 5266202, Israel; (A.L.); (Y.F.-N.)
- Medical Management Department, The Chaim Sheba Medical Center, Tel Hashomer 5266202, Israel
| | - Sara Apter
- Department of Imaging, The Chaim Sheba Medical Center, Tel Hashomer 5266202, Israel; (E.K.); (E.K.); (Y.I.); (S.A.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 5266202, Israel; (A.L.); (Y.F.-N.)
| | - Ehud Grossman
- Adelson Medical School, Ariel University, Ariel 4077625, Israel
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Sulu C, Yumuk VD. Treat Obesity to Treat Type 2 Diabetes Mellitus. Diabetes Ther 2024; 15:611-622. [PMID: 38310627 PMCID: PMC10942960 DOI: 10.1007/s13300-024-01536-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 01/15/2024] [Indexed: 02/06/2024] Open
Abstract
Obesity, a multifactorial, relapsing chronic disease, serves as a gateway to a spectrum of metabolic, cardiovascular, mechanical and mental health problems. Over the last few decades, the global prevalence of obesity has surged nearly threefold, mirroring the escalating rates of type 2 diabetes mellitus (T2DM). This parallel trajectory strongly suggests a cause-and-effect relationship between obesity and T2DM. Extensive research indicates that even modest weight gain elevates the risk of T2DM, favoring the notion of obesity being a root cause. This perspective finds robust support in numerous studies demonstrating the preventive effects of obesity management on the onset of T2DM. Beyond prevention, obesity management has been shown to enhance remission in individuals with T2DM and to decrease microvascular complications, cardiovascular risk factors, renal failure and heart failure. This evidence underpins the urgent need for global initiatives aimed at addressing obesity management as a key strategy in the prevention and management of T2DM and its complications.
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Affiliation(s)
- Cem Sulu
- Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa Street, No. 53, 34098, Fatih, Istanbul, Turkey
- European Association for the Study of Obesity-Collaborating Center for Obesity Management, Istanbul, Turkey
| | - Volkan Demirhan Yumuk
- Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa Street, No. 53, 34098, Fatih, Istanbul, Turkey.
- European Association for the Study of Obesity-Collaborating Center for Obesity Management, Istanbul, Turkey.
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7
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Kim TB, Ahn SY, Oh J, Bae EH, Chin HJ, Kim MG, Jo SK, Cho WY, Oh SW. The Impact of Obesity on Kidney Disease: Observational Cohort Study Analyzing 14,492 Kidney Biopsy Cases. J Korean Med Sci 2024; 39:e12. [PMID: 38258359 PMCID: PMC10803208 DOI: 10.3346/jkms.2024.39.e12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/10/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND The obesity epidemic is associated with the emergence of new kidney diseases including obesity-related glomerulopathy (ORG) and metabolic syndrome-associated disorders. However, the effects of obesity on prevalence and outcome of biopsy-proven kidney disease are not well known. METHODS We analyzed 14,492 kidney biopsies in 18 hospitals from 1979 to 2018 in Korea. Obesity was defined as a body mass index value of ≥ 30 kg/m². RESULTS The most common disease was IgA nephropathy (IgAN) in both obese and non-obese participants (33.7% vs. 38.9%). Obesity was associated with a higher risk of focal segmental glomerulosclerosis (FSGS) and hypertensive nephropathy (HT-N) (odds ratio [OR], 1.72, 95% confidence interval [CI], 1.37-2.17; OR, 1.96, 95% CI, 1.21-3.19) and a lower risk of IgAN (OR, 0.74, 95% CI, 0.62-0.88). During the median follow up of 93.1 ± 88.7 months, obesity increased the risk of end-stage kidney disease (ESKD) in patients with IgAN (relative risk [RR], 1.49, 95% CI, 1.01-2.20) and lupus nephritis (LN) (RR, 3.43, 95% CI, 1.36-8.67). Of 947 obese individuals, ORG was detected in 298 (31.5%), and 230 participants had other kidney diseases, most commonly, IgAN (40.9%) followed by diabetic nephropathy (15.2%). Participants with ORG, when combined with other renal diseases, showed higher risks for developing ESKD compared to those with ORG alone (RR, 2.48, 95% CI, 1.09-5.64). CONCLUSION Obesity is associated with an increased risk of FSGS and HT-N, and also increase the ESKD risk in IgAN and LN patients. ORG in obese participants may have favorable renal outcomes if it occurs alone without any other renal disease.
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Affiliation(s)
- Tae-Bum Kim
- Department of Internal Medicine, Goesan Sungmo Hospital, Goesan, Korea
| | - Shin Young Ahn
- Division of Nephrology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jieun Oh
- Division of Nephrology, Department of Internal Medicine, Hallym University College of Medicine, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Ho Jun Chin
- Division of Nephrology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Myung-Gyu Kim
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Sang Kyung Jo
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Won Yong Cho
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Se Won Oh
- Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea.
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8
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Chen TK, Hoenig MP, Nitsch D, Grams ME. Advances in the management of chronic kidney disease. BMJ 2023; 383:e074216. [PMID: 38052474 DOI: 10.1136/bmj-2022-074216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Chronic kidney disease (CKD) represents a global public health crisis, but awareness by patients and providers is poor. Defined as persistent abnormalities in kidney structure or function for more than three months, manifested as either low glomerular filtration rate or presence of a marker of kidney damage such as albuminuria, CKD can be identified through readily available blood and urine tests. Early recognition of CKD is crucial for harnessing major advances in staging, prognosis, and treatment. This review discusses the evidence behind the general principles of CKD management, such as blood pressure and glucose control, renin-angiotensin-aldosterone system blockade, statin therapy, and dietary management. It additionally describes individualized approaches to treatment based on risk of kidney failure and cause of CKD. Finally, it reviews novel classes of kidney protective agents including sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists, non-steroidal selective mineralocorticoid receptor antagonists, and endothelin receptor antagonists. Appropriate, widespread implementation of these highly effective therapies should improve the lives of people with CKD and decrease the worldwide incidence of kidney failure.
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Affiliation(s)
- Teresa K Chen
- Kidney Health Research Collaborative and Division of Nephrology, Department of Medicine, University of California San Francisco; and San Francisco VA Health Care System, San Francisco, CA, USA
| | - Melanie P Hoenig
- Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Morgan E Grams
- Department of Medicine, New York University Langone School of Medicine, New York, NY, USA
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9
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Bashir B, Iqbal Z, Adam S, Ferdousi M, Chick W, Hussein HA, Syed AA, Le Roux CW, Cohen RV, Malik RA, Soran H. Microvascular complications of obesity and diabetes-Role of bariatric surgery. Obes Rev 2023; 24:e13602. [PMID: 37515402 DOI: 10.1111/obr.13602] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 05/19/2023] [Accepted: 06/12/2023] [Indexed: 07/30/2023]
Abstract
Bariatric surgery in people with obesity can lead to long-term remission of type 2 diabetes mellitus (T2DM) and a reduction in the incidence of macrovascular complications. The impact of bariatric surgery on microvascular complications is less clear. In this narrative review, we sought to evaluate the effect of bariatric surgery on microvascular complications in patients with and without diabetes. The risk of developing microvascular complications is increased in people with obesity, and this is amplified in those with T2DM. The impact of metabolic surgery on microvascular complications is limited to a subgroup analysis of studies or statistical modeling to predict the glycemia-independent effect of bariatric surgery. While bariatric surgery halts the progression of retinopathy in those with minimal retinopathy, it may worsen in those with advanced retinopathy. Bariatric surgery improves proteinuria and major renal outcomes, regardless of the severity of renal impairment. Bariatric surgery in patients with obesity with or without diabetes is associated with an improvement in neuropathic symptoms and regeneration of small nerve fibers. In conclusion, bariatric surgery is associated with an improvement in microvascular complications. Further studies are needed to elucidate the underlying mechanisms for the favorable effect of bariatric surgery on microvascular outcomes.
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Affiliation(s)
- Bilal Bashir
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Centre for Diabetes, Endocrinology and Metabolism, Manchester University NHS Foundation Trust, Manchester, UK
| | - Zohaib Iqbal
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Centre for Diabetes, Endocrinology and Metabolism, Manchester University NHS Foundation Trust, Manchester, UK
| | - Safwaan Adam
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Department of Endocrinology, The Christie NHS Foundation Trust, Manchester, UK
| | - Maryam Ferdousi
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - William Chick
- Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK
| | | | - Akheel A Syed
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Department of Endocrinology, Diabetes and Obesity Medicine, Salford Royal Hospital NHS Foundation Trust, Salford, UK
| | - Carel W Le Roux
- Diabetes Complications Research Centre, School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
| | - Ricardo V Cohen
- The Centre for Obesity and Diabetes, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | - Rayaz A Malik
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Handrean Soran
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Centre for Diabetes, Endocrinology and Metabolism, Manchester University NHS Foundation Trust, Manchester, UK
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10
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Hti Lar Seng NS, Lohana P, Chandra S, Jim B. The Fatty Kidney and Beyond: A Silent Epidemic. Am J Med 2023; 136:965-974. [PMID: 37451390 DOI: 10.1016/j.amjmed.2023.06.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Abstract
As the prevalence of obesity rises in the United States, so does the incidence of obesity-related kidney disease. Obesity itself is an independent risk factor for chronic kidney disease where the pathophysiology is complex, involving altered hemodynamics, renin-angiotensin-aldosterone system overactivation, and adipokines leading to inflammation and fibrosis. Obesity-related kidney disease comprises both obesity-related glomerulopathy and fatty kidney disease. Obesity-related glomerulopathy is a consequence of glomerular hyperfiltration and often presents clinically with subnephrotic proteinuria and pathologically with glomerulomegaly with or without focal glomerulosclerosis. Fatty kidney disease is the effect of renal ectopic fat contributing to chronic kidney disease. Whether the renal ectopic fat is a distinct clinical entity or a pathologic mechanism contributing to obesity-related glomerulopathy, the treatment paradigm of weight and proteinuria reduction remains the same. We present the pathophysiology behind obesity-related kidney disease, clinical outcomes, and treatment strategies, which include lifestyle interventions, use of renin-angiotensin-aldosterone system inhibitors, glucagon-like peptide 1 receptor agonists, sodium-glucose co-transporter-2 inhibitors, and bariatric surgery. With old and novel therapeutics, we are attempting to stave off the silent epidemic that obesity-related kidney disease is becoming.
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Affiliation(s)
- Nang San Hti Lar Seng
- Division of Nephrology, Department of Medicine, Jacobi Medical Center at Albert Einstein College of Medicine Bronx, NY
| | - Petras Lohana
- Division of Nephrology, Department of Medicine, Jacobi Medical Center at Albert Einstein College of Medicine Bronx, NY
| | - Shruti Chandra
- Division of Nephrology, Department of Medicine, Jacobi Medical Center at Albert Einstein College of Medicine Bronx, NY
| | - Belinda Jim
- Division of Nephrology, Department of Medicine, Jacobi Medical Center at Albert Einstein College of Medicine Bronx, NY.
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11
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Scherer L, Schönauer R, Nemitz-Kliemchen M, Hagemann T, Hantmann E, de Fallois J, Petzold F, Blüher M, Halbritter J. Delta weight loss unlike genetic variation associates with hyperoxaluria after malabsorptive bariatric surgery. Sci Rep 2023; 13:9029. [PMID: 37270618 DOI: 10.1038/s41598-023-35941-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 05/26/2023] [Indexed: 06/05/2023] Open
Abstract
The risk of enteric hyperoxaluria is significantly increased after malabsorptive bariatric surgery (MBS). However, its underlying determinants are only poorly characterized. In this case-control study, we aimed at identifying clinical and genetic factors to dissect their individual contributions to the development of post-surgical hyperoxaluria. We determined the prevalence of hyperoxaluria and nephrolithiasis after MBS by 24-h urine samples and clinical questionnaires at our obesity center. Both hyperoxaluric and non-hyperoxaluric patients were screened for sequence variations in known and candidate genes implicated in hyperoxaluria (AGXT, GRHPR, HOGA1, SLC26A1, SLC26A6, SLC26A7) by targeted next generation sequencing (tNGS). The cohort comprised 67 patients, 49 females (73%) and 18 males (27%). While hyperoxaluria was found in 29 patients (43%), only one patient reported postprocedural nephrolithiasis within 41 months of follow-up. Upon tNGS, we did not find a difference regarding the burden of (rare) variants between hyperoxaluric and non-hyperoxaluric patients. However, patients with hyperoxaluria showed significantly greater weight loss accompanied by markers of intestinal malabsorption compared to non-hyperoxaluric controls. While enteric hyperoxaluria is very common after MBS, genetic variation of known hyperoxaluria genes contributes little to its pathogenesis. In contrast, the degree of postsurgical weight loss and levels of malabsorption parameters may allow for predicting the risk of enteric hyperoxaluria and consecutive kidney stone formation.
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Affiliation(s)
- Lotte Scherer
- Division of Nephrology, University of Leipzig Medical Center, Leipzig, Germany
| | - Ria Schönauer
- Division of Nephrology, University of Leipzig Medical Center, Leipzig, Germany
- Department of Nephrology and Internal Intensive Care Medicine, Charité University, Berlin, Germany
| | - Melanie Nemitz-Kliemchen
- Department of Nephrology and Internal Intensive Care Medicine, Charité University, Berlin, Germany
| | - Tobias Hagemann
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Zentrum München at the University of Leipzig, Ph.-Rosenthal-Str. 27, 04103, Leipzig, Germany
| | - Elena Hantmann
- Department of Nephrology and Internal Intensive Care Medicine, Charité University, Berlin, Germany
| | - Jonathan de Fallois
- Division of Nephrology, University of Leipzig Medical Center, Leipzig, Germany
| | - Friederike Petzold
- Division of Nephrology, University of Leipzig Medical Center, Leipzig, Germany
| | - Matthias Blüher
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Zentrum München at the University of Leipzig, Ph.-Rosenthal-Str. 27, 04103, Leipzig, Germany
| | - Jan Halbritter
- Division of Nephrology, University of Leipzig Medical Center, Leipzig, Germany.
- Department of Nephrology and Internal Intensive Care Medicine, Charité University, Berlin, Germany.
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12
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Verde L, Lucà S, Cernea S, Sulu C, Yumuk VD, Jenssen TG, Savastano S, Sarno G, Colao A, Barrea L, Muscogiuri G. The Fat Kidney. Curr Obes Rep 2023:10.1007/s13679-023-00500-9. [PMID: 36933154 DOI: 10.1007/s13679-023-00500-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 03/19/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the current evidence on the role of obesity in the development and progression of chronic kidney disease and the current evidence on nutritional, pharmacological, and surgical strategies for the management of individuals with obesity and chronic kidney disease. RECENT FINDINGS Obesity can hurt the kidney via direct pathways, through the production of pro-inflammatory adipocytokines, and indirectly due to systemic complications of obesity, including type 2 diabetes mellitus and hypertension. In particular, obesity can damage the kidney through alterations in renal hemodynamics resulting in glomerular hyperfiltration, proteinuria and, finally, impairment in glomerular filtratation rate. Several strategies are available for weight loss and maintenance, such as the modification of lifestyle (diet and physical activity), anti-obesity drugs, and surgery therapy, but there are no clinical practice guidelines to manage subjects with obesity and chronic kidney disease. Obesity is an independent risk factor for the progression of chronic kidney disease. In subjects with obesity, weight loss can slow down the progression of renal failure with a significant reduction in proteinuria and improvement in glomerular filtratation rate. Specifically, in the management of subjects with obesity and chronic renal disease, it has been shown that bariatric surgery can prevent the decline in renal function, while further clinical studies are needed to evaluate the efficacy and safety on the kidney of weight reducing agents and the very low-calorie ketogenic diet.
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Affiliation(s)
- Ludovica Verde
- Department of Public Health, University of Naples Federico II, Naples, Italy
- Centro Italiano Per La Cura E il Benessere del Paziente con Obesità (C.I.B.O), University of Naples Federico II, Naples, Italy
| | - Stefania Lucà
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, 88100, Catanzaro, Italy
| | - Simona Cernea
- Technology of Târgu Mures/Internal Medicine I, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureş, Romania
- Diabetes, Nutrition and Metabolic Diseases Outpatient Unit, Emergency County Clinical Hospital, Târgu Mureş, Romania
| | - Cem Sulu
- Division of Endocrinology, Metabolism and Diabetes, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Volkan Demirhan Yumuk
- Division of Endocrinology, Metabolism and Diabetes, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Trond Geir Jenssen
- Department of Transplantation Medicine, Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | - Silvia Savastano
- Centro Italiano Per La Cura E il Benessere del Paziente con Obesità (C.I.B.O), University of Naples Federico II, Naples, Italy
- Dipartimento di Medicina Clinica e Chirurgia, Diabetologia e Andrologia, Unità di Endocrinologia, Università degli Studi Di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Gerardo Sarno
- General Surgery and Kidney Transplantation Unit, d'Aragona University Hospital, San Giovanni di Dio e Ruggid, 84131, Salerno, Italy
| | - Annamaria Colao
- Centro Italiano Per La Cura E il Benessere del Paziente con Obesità (C.I.B.O), University of Naples Federico II, Naples, Italy
- Dipartimento di Medicina Clinica e Chirurgia, Diabetologia e Andrologia, Unità di Endocrinologia, Università degli Studi Di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Cattedra Unesco Educazione alla salute e allo sviluppo sostenibile, University Federico II, Naples, Italy
| | - Luigi Barrea
- Centro Italiano Per La Cura E il Benessere del Paziente con Obesità (C.I.B.O), University of Naples Federico II, Naples, Italy
- Dipartimento di Scienze Umanistiche, Centro Direzionale, Università Telematica Pegaso, Via Porzio, Isola F2, 80143, Naples, Italy
| | - Giovanna Muscogiuri
- Centro Italiano Per La Cura E il Benessere del Paziente con Obesità (C.I.B.O), University of Naples Federico II, Naples, Italy.
- Dipartimento di Medicina Clinica e Chirurgia, Diabetologia e Andrologia, Unità di Endocrinologia, Università degli Studi Di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.
- Cattedra Unesco Educazione alla salute e allo sviluppo sostenibile, University Federico II, Naples, Italy.
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13
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A 5-year propensity-matched analysis of perioperative outcomes in patients with chronic kidney disease undergoing bariatric surgery. Surg Endosc 2023; 37:2335-2346. [PMID: 36401102 DOI: 10.1007/s00464-022-09756-z] [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: 06/13/2022] [Accepted: 11/01/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Bariatric surgery can improve renal function in patients with comorbid chronic kidney disease (CKD) and obesity. Additionally, bariatric surgery can enhance outcomes following renal transplantation. The safety of bariatric surgery in patients with CKD has been debated in the literature. This study evaluates the frequency of perioperative complications associated with CKD. METHODS The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database was queried from 2015-2019. Patients were included if they had a vertical sleeve gastrectomy (VSG) or Roux-en-Y gastric bypass (RYGB) and were stratified based on CKD status. An unmatched and propensity-matched analysis was performed comparing 30-day perioperative outcomes between the groups. RESULTS A total of 717,809 patients included in this study, 5817(0.8%) had CKD, of whom 2266(0.3%) were on dialysis. 74.3% of patients with CKD underwent VSG with 25.7% underwent RYGB. Comparing RYGB to VSG, patients who underwent RYGB had a higher rate of deep organ space infection (0.7%vs.0.1%,p = 0.021) and re-intervention (5.0% vs. 2.2%,p < 0.001). Within the VSG cohort, a matched analysis was performed for those with CKD and without CKD. The CKD cohort had higher risk of complications such as bleeding (2.1%vs. 0.9%,p < 0.001), readmission (9.3%vs.4.9%,p < 0.001), reoperation (2.7%vs.1.3%,p < 0.001), and need for reintervention (2.2%vs.1.3%,p < 0.001). Notably, patients with CKD also had a higher mortality (0.6%vs.0.2%,p = 0.003). No difference was seen between patients with renal insufficiency and patients on dialysis. CONCLUSION VSG has been the operation of choice in patients with CKD. Our results showed it is the safer option for patients with CKD compared to RYGB. Although this patient population does have an increased risk of adverse perioperative events, dialysis didn't affect the outcome. Bariatric surgeons who operate on patients with CKD should be well informed and remain vigilant given the increased perioperative risk. The risk is still considerably low, and the potential benefit on renal function and improvement in candidacy for renal transplant outweigh the risk. They should be considered as surgical candidates.
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14
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Siener R, Metzner C. Dietary weight loss strategies for kidney stone patients. World J Urol 2023; 41:1221-1228. [PMID: 36593299 DOI: 10.1007/s00345-022-04268-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/19/2022] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Overweight has been associated with an increased risk of incident and recurrent kidney stone disease. Weight reduction is the therapeutic consequence to decrease the risk of stone formation. This review examines the effectiveness of different weight loss strategies on weight reduction and cardiometabolic risk profile, with a particular focus on risk factors for urolithiasis. METHODS A selective literature search was performed using PubMed and Cochrane library. RESULTS Clinical evidence for the potential benefits of dietary weight loss strategies for kidney stone disease is limited. A conventional, energy-restricted diet may significantly induce weight loss and reduce urinary supersaturation of calcium oxalate in overweight individuals with or without a history of stone formation. The current data indicate that an energy-restricted diet with partial meal replacement may additionally decrease the relative supersaturation of uric acid and further improve the cardiometabolic risk profile, and, thus, may be a favourable option for overweight kidney stone patients. Studies on the Mediterranean and DASH diets on the association between weight loss and the risk of urinary stone formation are lacking. CONCLUSION An energy-restricted diet with or without meal replacement could be a promising weight loss strategy for overweight kidney stone patients. Further studies are needed to evaluate the impact of different weight loss strategies on urinary risk factors and cardiometabolic risk profile in urolithiasis.
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Affiliation(s)
- Roswitha Siener
- Department of Urology, University Stone Center, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Christine Metzner
- Bonn Education Association for Dietetics r. A., Cologne, Germany.,Clinic for Gastroenterology, Metabolic Disorders and Internal Intensive Medicine (Medical Clinic III), RWTH, Aachen, Germany
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15
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Ardiles LG. Obesity and renal disease: Benefits of bariatric surgery. Front Med (Lausanne) 2023; 10:1134644. [PMID: 36926320 PMCID: PMC10011092 DOI: 10.3389/fmed.2023.1134644] [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: 12/30/2022] [Accepted: 01/25/2023] [Indexed: 03/04/2023] Open
Abstract
The prevalence of obesity, a preventable and reversible condition with a high impact on health, continues to rise, especially after the COVID-19 pandemic. Severe overweight is well recognized as a risk factor for diabetes and hypertension, among other conditions, that may increase cardiovascular risk. Obesity has grown simultaneously with a rise in the prevalence of chronic kidney disease, and a pathophysiological link has been established, which explains its role in generating the conditions to facilitate the emergence and maximize the impact of the risk factors of chronic kidney disease and its progression to more advanced stages. Knowing the mechanisms involved and having different tools to reverse the overweight and its consequences, bariatric surgery has arisen as a useful and efficient method, complementary or alternative to others, such as lifestyle changes and/or pharmacotherapy. In a detailed review, the mechanisms involved in the renal consequences of obesity, the impact on risk factors, and the potential benefit of bariatric surgery at different stages of the disease and its progression are exposed and analyzed. Although the observational evidence supports the value of bariatric surgery as a renoprotective measure in individuals with obesity, diabetic or not, randomized studies are expected to establish evidence-based recommendations that demonstrate its positive risk-benefit balance as a complementary or alternative therapeutic tool.
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Affiliation(s)
- Leopoldo G Ardiles
- Department of Nephrology, Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile
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16
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Abstract
The prevalence of obesity has increased dramatically during the past decades, which has been a major health problem. Since 1975, the number of people with obesity worldwide has nearly tripled. An increasing number of studies find obesity as a driver of chronic kidney disease (CKD) progression, and the mechanisms are complex and include hemodynamic changes, inflammation, oxidative stress, and activation of the renin-angiotensin-aldosterone system (RAAS). Obesity-related kidney disease is characterized by glomerulomegaly, which is often accompanied by localized and segmental glomerulosclerosis lesions. In these patients, the early symptoms are atypical, with microproteinuria being the main clinical manifestation and nephrotic syndrome being rare. Weight loss and RAAS blockers have a protective effect on obesity-related CKD, but even so, a significant proportion of patients eventually progress to end-stage renal disease despite treatment. Thus, it is critical to comprehend the mechanisms underlying obesity-related CKD to create new tactics for slowing or stopping disease progression. In this review, we summarize current knowledge on the mechanisms of obesity-related kidney disease, its pathological changes, and future perspectives on its treatment.
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Affiliation(s)
- Zongmiao Jiang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Yao Wang
- Department of Orthopedics, The Second Hospital Jilin University, Changchun, China
| | - Xue Zhao
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Haiying Cui
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Mingyue Han
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Xinhua Ren
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Xiaokun Gang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Guixia Wang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
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17
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Potrykus M, Czaja-Stolc S, Małgorzewicz S, Proczko-Stepaniak M, Dębska-Ślizień A. Diet Management of Patients with Chronic Kidney Disease in Bariatric Surgery. Nutrients 2022; 15:nu15010165. [PMID: 36615822 PMCID: PMC9824280 DOI: 10.3390/nu15010165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/23/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022] Open
Abstract
Morbid obesity is considered a civilization disease of the 21st century. Not only does obesity increase mortality, but it is also the most important cause of the shortening life expectancy in the modern world. Obesity is associated with many metabolic abnormalities: dyslipidemia, hyperglycemia, cardiovascular diseases, and others. An increasing number of patients diagnosed with chronic kidney disease (CKD) are obese. Numerous additional disorders associated with impaired kidney function make it difficult to conduct slimming therapy and may also be associated with a greater number of complications than in people with normal kidney function. Currently available treatments for obesity include lifestyle modification, pharmacotherapy, and bariatric surgery (BS). There are no precise recommendations on how to reduce excess body weight in patients with CKD treated conservatively, undergoing chronic dialysis, or after kidney transplantation. The aim of this study was to analyze studies on the bariatric treatment of obesity in this group of people, as well as to compare the recommendations typical for bariatrics and CKD.
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Affiliation(s)
- Marta Potrykus
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, 80-211 Gdańsk, Poland
| | - Sylwia Czaja-Stolc
- Department of Clinical Nutrition, Medical University of Gdansk, 80-211 Gdańsk, Poland
- Correspondence: ; Tel.: +48-(58)-349-27-24
| | - Sylwia Małgorzewicz
- Department of Clinical Nutrition, Medical University of Gdansk, 80-211 Gdańsk, Poland
| | - Monika Proczko-Stepaniak
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, 80-211 Gdańsk, Poland
| | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdansk, 80-952 Gdańsk, Poland
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18
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Friedman AN, Schauer PR, Beddhu S, Kramer H, le Roux CW, Purnell JQ, Sunwold D, Tuttle KR, Jastreboff AM, Kaplan LM. Obstacles and opportunities in managing coexisting obesity and CKD: Report of a scientific workshop cosponsored by the National Kidney Foundation and The Obesity Society. Obesity (Silver Spring) 2022; 30:2340-2350. [PMID: 36268562 DOI: 10.1002/oby.23599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 09/19/2022] [Indexed: 01/04/2023]
Abstract
The National Kidney Foundation (NKF) and The Obesity Society (TOS) cosponsored a multispecialty international workshop in April 2021 to advance the understanding and management of obesity in adults with chronic kidney disease (CKD). The underlying rationale for the workshop was the accumulating evidence that obesity is a major contributor to CKD and adverse outcomes in individuals with CKD, and that effective treatment of obesity, including lifestyle intervention, weight loss medications, and metabolic surgery, can have beneficial effects. The attendees included a range of experts in the areas of kidney disease, obesity medicine, endocrinology, diabetes, bariatric/metabolic surgery, endoscopy, transplant surgery, and nutrition, as well as patients with obesity and CKD. The group identified strategies to increase patient and provider engagement in obesity management, outlined a collaborative action plan to engage nephrologists and obesity medicine experts in obesity management, and identified research opportunities to address gaps in knowledge about the interaction between obesity and kidney disease. The workshop's conclusions help lay the groundwork for development of an effective, scientifically based, and multidisciplinary approach to the management of obesity in people with CKD.
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Affiliation(s)
- Allon N Friedman
- Division of Nephrology, School of Medicine, Indiana University Indianapolis, Indiana, USA
| | - Philip R Schauer
- Pennington Biomedical Research Institute, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Srinivasan Beddhu
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Holly Kramer
- Department of Public Health Sciences and Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Carel W le Roux
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland
| | - Jonathan Q Purnell
- Division of Cardiovascular Medicine, School of Medicine, Oregon Health & Science University, Oregon, Portland, USA
| | - Duane Sunwold
- Culinary Program, Spokane Community College, Spokane, Washington, USA
| | - Katherine R Tuttle
- Providence Health Care and School of Medicine, University of Washington, Spokane, Washington, USA
| | - Ania M Jastreboff
- Endocrinology & Metabolism, Department of Medicine and Pediatric Endocrinology, Department of Pediatrics, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Lee M Kaplan
- Obesity, Metabolism, and Nutrition Institute and Gastroenterology Division, Massachusetts General Hospital, and Medical School, Harvard University, Boston, Massachusetts, USA
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19
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Friedman AN, Schauer PR, Beddhu S, Kramer H, le Roux CW, Purnell JQ, Sunwold D, Tuttle KR, Jastreboff AM, Kaplan LM. Obstacles and Opportunities in Managing Coexisting Obesity and CKD: Report of a Scientific Workshop Cosponsored by the National Kidney Foundation and The Obesity Society. Am J Kidney Dis 2022; 80:783-793. [PMID: 36280397 DOI: 10.1053/j.ajkd.2022.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/14/2022] [Indexed: 11/06/2022]
Abstract
The National Kidney Foundation (NKF) and The Obesity Society (TOS) cosponsored a multispecialty international workshop in April 2021 to advance the understanding and management of obesity in adults with chronic kidney disease (CKD). The underlying rationale for the workshop was the accumulating evidence that obesity is a major contributor to CKD and adverse outcomes in individuals with CKD, and that effective treatment of obesity, including lifestyle intervention, weight loss medications, and metabolic surgery, can have beneficial effects. The attendees included a range of experts in the areas of kidney disease, obesity medicine, endocrinology, diabetes, bariatric/metabolic surgery, endoscopy, transplant surgery, and nutrition, as well as patients with obesity and CKD. The group identified strategies to increase patient and provider engagement in obesity management, outlined a collaborative action plan to engage nephrologists and obesity medicine experts in obesity management, and identified research opportunities to address gaps in knowledge about the interaction between obesity and kidney disease. The workshop's conclusions help lay the groundwork for development of an effective, scientifically based, and multidisciplinary approach to the management of obesity in people with CKD.
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Affiliation(s)
- Allon N Friedman
- Division of Nephrology, School of Medicine, Indiana University, Indianapolis, Indiana.
| | - Philip R Schauer
- Pennington Biomedical Research Institute, Louisiana State University, Baton Rouge, Louisiana
| | - Srinivasan Beddhu
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Holly Kramer
- Department of Public Health Sciences and Medicine, Loyola University Chicago, Maywood, Illinois
| | - Carel W le Roux
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland
| | | | - Duane Sunwold
- Culinary Program, Spokane Community College, Spokane, Washington
| | - Katherine R Tuttle
- Providence Health Care and School of Medicine, University of Washington, Spokane and Seattle, Washington
| | - Ania M Jastreboff
- Endocrinology & Metabolism, Department of Medicine and Pediatric Endocrinology, Department of Pediatrics, School of Medicine, Yale University, New Haven, Connecticut
| | - Lee M Kaplan
- Obesity, Metabolism, and Nutrition Institute and Gastroenterology Division, Massachusetts General Hospital, and Medical School, Harvard University, Boston, Massachusetts
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20
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Coleman KJ, Shu YH, Fischer H, Johnson E, Yoon TK, Taylor B, Imam T, DeRose S, Haneuse S, Herrinton LJ, Fisher D, Li RA, Theis MK, Liu L, Courcoulas AP, Smith DH, Arterburn DE, Friedman AN. Bariatric Surgery and Risk of Death in Persons With Chronic Kidney Disease. Ann Surg 2022; 276:e784-e791. [PMID: 33914480 PMCID: PMC8413380 DOI: 10.1097/sla.0000000000004851] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE A retrospective cohort study investigated the association between having surgery and risk of mortality for up to 5 years and if this association was modified by incident ESRD during the follow-up period. Summary of Background Data: Mortality risk in individuals with pre-dialysis CKD is high and few effective treatment options are available. Whether bariatric surgery can improve survival in people with CKD is unclear. METHODS Patients with class II and III obesity and pre-dialysis CKD stages 3-5 who underwent bariatric surgery between January 1, 2006 and September 30, 2015 (n = 802) were matched to patients who did not have surgery (n = 4933). Mortality was obtained from state death records and ESRD was identified through state-based or healthcare system-based registries. Cox regression models were used to investigate the association between bariatric surgery and risk of mortality and if this was moderated by incident ESRD during the follow-up period. RESULTS Patients were primarily women (79%), non-Hispanic White (72%), under 65 years old (64%), who had a body mass index > 40kg/m 2 (59%), diabetes (67%), and hypertension (89%). After adjusting for incident ESRD, bariatric surgery was associated with a 79% lower 5-year risk of mortality compared to matched controls (hazard ratio = 0.21; 95% confidence interval: 0.14-0.32; P < 0.001). Incident ESRD did not moderate the observed association between surgery and mortality (hazard ratio = 1.59; 95% confidence interval: 0.31-8.23; P =0.58). CONCLUSIONS Bariatric surgery is associated with a reduction in mortality in pre-dialysis patients regardless of developing ESRD. These findings are significant because patients with CKD are at relatively high risk for death with few efficacious interventions available to improve survival.
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Affiliation(s)
- Karen J. Coleman
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, CA
| | - Yu-Hsiang Shu
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, CA
| | - Heidi Fischer
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, CA
| | - Eric Johnson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Tae K. Yoon
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, CA
| | - Brianna Taylor
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, CA
| | - Talha Imam
- Kaiser Permanente Southern California, Nephrology Department, San Bernardino Medical Center, Fontana, CA
| | - Stephen DeRose
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, CA
| | | | - Lisa J. Herrinton
- Kaiser Permanente Northern California, Division of Research, Oakland, CA
| | - David Fisher
- Kaiser Permanente Northern California, Division of Research, Oakland, CA
| | - Robert A Li
- Kaiser Permanente Northern California, Department of Surgery, Oakland, CA
| | - Mary Kay Theis
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Liyan Liu
- Kaiser Permanente Northern California, Division of Research Oakland, CA
| | - Anita P Courcoulas
- University of Pittsburgh Medical Center, School of Medicine, Pittsburgh, PA
| | - David H. Smith
- Kaiser Permanente Northwest, Center for Health Research, Portland, OR
| | | | - Allon N. Friedman
- Division of Nephrology Indiana University School of Medicine, Indianapolis, IN
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21
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Moriconi D, Nannipieri M, Dadson P, Rosada J, Tentolouris N, Rebelos E. The Beneficial Effects of Bariatric-Surgery-Induced Weight Loss on Renal Function. Metabolites 2022; 12:967. [PMID: 36295869 PMCID: PMC9608617 DOI: 10.3390/metabo12100967] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/08/2022] [Accepted: 10/08/2022] [Indexed: 08/05/2023] Open
Abstract
Obesity represents an independent risk factor for the development of chronic kidney disease (CKD), leading to specific histopathological alterations, known as obesity-related glomerulopathy. Bariatric surgery is the most effective means of inducing and maintaining sustained weight loss. Furthermore, in the context of bariatric-surgery-induced weight loss, a reduction in the proinflammatory state and an improvement in the adipokine profile occur, which may also contribute to the improvement of renal function following bariatric surgery. However, the assessment of renal function in the context of obesity and following marked weight loss is difficult, since the formulas adopted to estimate glomerular function use biomarkers whose production is dependent on muscle mass (creatinine) or adipose tissue mass and inflammation (cystatin-c). Thus, following bariatric surgery, the extent to which reductions in plasma concentrations reflect the actual improvement in renal function is not clear. Despite this limitation, the available literature suggests that in patients with hyperfiltration at baseline, GFR is reduced following bariatric surgery, whereas GFR is increased in patients with decreased GFR at baseline. These findings are also confirmed in the few studies that have used measured rather than estimated GFR. Albuminuria is also decreased following bariatric surgery. Moreover, bariatric surgery seems superior in achieving the remission of albuminuria and early CKD than the best medical treatment. In this article, we discuss the pathophysiology of renal complications in obesity, review the mechanisms through which weight loss induces improvements in renal function, and provide an overview of the renal outcomes following bariatric surgery.
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Affiliation(s)
- Diego Moriconi
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Monica Nannipieri
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Prince Dadson
- Turku PET Centre, University of Turku, 20500 Turku, Finland
| | - Javier Rosada
- Fourth Unit of Internal Medicine, University Hospital of Pisa, 56124 Pisa, Italy
| | - Nikolaos Tentolouris
- Department of Propaedeutic and Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece
| | - Eleni Rebelos
- Turku PET Centre, University of Turku, 20500 Turku, Finland
- Institute of Clinical Physiology, National Research Council (CNR), 56124 Pisa, Italy
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22
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Lin L, Tan W, Pan X, Tian E, Wu Z, Yang J. Metabolic Syndrome-Related Kidney Injury: A Review and Update. Front Endocrinol (Lausanne) 2022; 13:904001. [PMID: 35813613 PMCID: PMC9261267 DOI: 10.3389/fendo.2022.904001] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/09/2022] [Indexed: 11/15/2022] Open
Abstract
Metabolic syndrome (MetS) includes visceral obesity, hyperglycemia, dyslipidemia, and hypertension. The prevalence of MetS is 20-25%, which is an important risk factor for chronic kidney disease (CKD). MetS causes effects on renal pathophysiology, including glomerular hyperfiltration, RAAS, microalbuminuria, profibrotic factors and podocyte injury. This review compares several criteria of MetS and analyzes their differences. MetS and the pathogenesis of CKD includes insulin resistance, obesity, dyslipidemia, inflammation, oxidative stress, and endothelial dysfunction. The intervention of MetS-related renal damage is the focus of this article and includes controlling body weight, hypertension, hyperglycemia, and hyperlipidemia, requiring all components to meet the criteria. In addition, interventions such as endoplasmic reticulum stress, oxidative stress, gut microbiota, body metabolism, appetite inhibition, podocyte apoptosis, and mesenchymal stem cells are reviewed.
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Affiliation(s)
- Lirong Lin
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Wei Tan
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Xianfeng Pan
- Department of Nephrology, Chongqing Kaizhou District People’s Hospital of Chongqing, Chongqing, China
| | - En Tian
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Zhifeng Wu
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
| | - Jurong Yang
- Department of Nephrology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China
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23
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Wu T, Wong CKH, Tang EHM, Man KKC, Wong SKH, Ho Au IC, Tse ETY, Chan EWY, Grieve E, Wu O, Ng EKW, Wong ICK. The comparative effects of metabolic surgery, SGLT2i, or GLP-1RA in patients with obesity and type 2 diabetes: A retrospective cohort study. Surg Obes Relat Dis 2022; 18:762-771. [DOI: 10.1016/j.soard.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/28/2022] [Accepted: 02/07/2022] [Indexed: 11/29/2022]
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24
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Balata MG, Helal AH, Mohamed AH, Habib AU, Awad M, Sherif M. Gouty arthritis and kidney function outcomes and serum uric acid level variations in obese patients following bariatric surgery. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2022. [DOI: 10.1186/s43162-021-00091-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Obesity is an independent risk factor for chronic kidney disease (CKD) and is the strongest known modifiable risk factor for hyperuricemia and gout. We aimed to discover the outcome of serum uric acid (SUA), gouty arthritis, and kidney function in obese patients after bariatric surgery and possible links with BMI variations.
Methods
Retrospective study has been performed in National Hospital in Riyadh, KSA, between Jan. 2018 to Jan. 2020. We studied only 98 patients who met our inclusion criteria. Patients followed-up at 1 month (for gouty attack only) postoperative, 3 months postoperative, and 6 months postoperative for body mass index (BMI), serum creatinine, dipstick urinalysis, SUA, and estimated glomerular filtration rate (eGFR). Radiological studies, medical history, follow up radiological studies, and clinical follow up were obtained from the hospital data system.
Results
A total of 98 patients with mean eGFR were 90.65 ± 29.34 ml/min/1.73 m2, mean SUA 5.56 ± 1.84 mg/dl, and mean BMI was 45.28 ± 7.25 kg/m2, at surgery. Mean BMI had decreased significantly to 38.52 ± 6.05 kg/m2 at 3 months and to 34.61 ± 5.35 kg/m2 at 6 months (P < 0.001). The mean GFR had improved significantly (99.14 ± 23.32 ml/min/1.73 m2) at 6 months (P < 0.001). Interestingly, proteinuria had resolved in 17 patients out of 23 patients at 6 months. Number of gouty attacks was decreased during the first month post-surgery (P < 0.001). SUA level was significantly decreased (4.32 ± 1.27 mg/dl) (P < 0.001). SUA showed significant negative correlations with eGFR at 3 months and positively significant correlations with BMI at 3 and 6 months. By multinomial logistic regression, BMI and initial eGFR were the independent predictive variables for the outcome of eGFR at 6 months, while male gender and initial SUA were the independent predictive variables on the outcome of SUA at 6 months. Postoperatively in gouty arthritis patients, the number of joints affected, patient global VAS assessment, and number of gouty attacks were significantly reduced (P < 0.001).
Conclusion
Bariatric surgery has been associated with reduction of BMI and subsequently reduction of SUA levels, gouty attacks, and improvement of eGFR.
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25
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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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26
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Wee Z, Ganguly S, Tham KW, Lim CH, Tan JTH, Lee PC. Renal Outcomes 1 Year After Metabolic Bariatric Surgery in a Multi-ethnic Asian Cohort. Obes Surg 2021; 31:5358-5366. [PMID: 34586568 DOI: 10.1007/s11695-021-05732-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/17/2021] [Accepted: 09/22/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE Obesity increases the risk of incident chronic kidney disease (CKD) and is one of the strongest risk factors for new-onset CKD even in the absence of metabolic risk factors. Weight loss has been shown to reduce renal hyperfiltration and proteinuria. Metabolic bariatric surgery (MBS) remains an effective treatment for obesity and its metabolic-related complications. However, literature on its impact on renal function remains limited. MATERIALS AND METHODS This was an observational retrospective study in a tertiary centre in Singapore. MBS cases performed at the centre between 2008 and 2019 were included. The primary outcome measures were estimated glomerular filtration rate (eGFR), calculated using the CKD epidemiology collaboration equation, and albuminuria (defined as urine albumin-creatinine ratio (uACR) > 3.5 mg/mmol) at baseline and 1-year post-MBS. RESULTS Five hundred fifty-seven patients were included. One-year post-MBS, median eGFR increased from 110.9 mL/min/1.73 m2 (IQR 92.4 to 121.5) to 112.6 mL/min/1.73 m2 (IQR 97.3 to 122.3), p < 0.001. Median uACR decreased from 1.00 mg/mmol (IQR 0.40 to 3.55) to 0.70 mg/mmol (IQR 0.40 to 1.80) 1-year post-MBS (p = 0.001). 12.9% of patients had improved CKD staging. The proportion of patients with albuminuria decreased from 24.8% at baseline to 1.89% 1-year post-MBS (p < 0.001). One-year post-MBS, the subgroup with reduced eGFR had significant increases in eGFR (p < 0.001), with a trend towards a reduction in uACR. CONCLUSIONS MBS had a positive impact on renal function with modest but statistically significant improvement in eGFR and reduction in albuminuria at 1-year post-surgery. Longer-term data is required to investigate the durability of this impact.
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Affiliation(s)
- Zongwen Wee
- Department of Endocrinology, Singapore General Hospital, 20 College Road, Academia, Singapore, 169856, Singapore.
| | - Sonali Ganguly
- Department of Endocrinology, Singapore General Hospital, 20 College Road, Academia, Singapore, 169856, Singapore
| | - Kwang Wei Tham
- Singapore Association for the Study of Obesity, 6 Napier Road #09-17, Singapore, 258449, Singapore
| | - Chin Hong Lim
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, 20 College Road, Academia, Singapore, 169856, Singapore
| | - Jeremy Tian Hui Tan
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, 20 College Road, Academia, Singapore, 169856, Singapore
| | - Phong Ching Lee
- Department of Endocrinology, Singapore General Hospital, 20 College Road, Academia, Singapore, 169856, Singapore
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27
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Abstract
Obesity-related glomerulopathy (ORG) and other obesity-associated kidney diseases pose a major challenge to the treating nephrologist. We review the benefits of weight loss and optimal management of ORG and kidney disease in the setting of obesity. Therapeutic strategies in ORG were limited mainly in the past to weight loss through lifestyle interventions and bariatric surgery, antihypertensive treatment, and renin-angiotensin-aldosterone system blockade. Current approaches to obtain the desired weight loss include novel pharmacologic therapies that have been approved for the treatment of diabetes while offering kidney protection, such as sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1-receptor agonists. This review focuses on the nephroprotective role of the renin-angiotensin-aldosterone system blockade and of these new pharmacologic agents, and on the renal effects of bariatric surgery in chronic kidney disease.
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Affiliation(s)
- Michal Herman-Edelstein
- Nephrology Department, Rabin Medical Center, Petach Tikva, Israel; Nephrology Research Laboratory, Felsenstein Medical Research Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Talia Weinstein
- Department of Nephrology and Hypertension, Tel Aviv Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
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28
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Abernathy OL, Okut H, Paull-Forney BG, Schwasinger-Schmidt TE. Bariatric Surgery Improves Renal Function in Patients With Obesity. Cureus 2021; 13:e17458. [PMID: 34603860 PMCID: PMC8475746 DOI: 10.7759/cureus.17458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2021] [Indexed: 12/11/2022] Open
Abstract
Background Obesity affects 93.3 million adults in the United States and is a predisposing factor for the development and progression of chronic kidney disease (CKD). The objective of this study is to examine the association between weight loss and renal function in participants undergoing bariatric surgery following a 12-week multidisciplinary, community-based weight loss program. Methodology This is a retrospective chart review of participants who voluntarily enrolled in a 12-week multidisciplinary weight loss program prior to bariatric surgery from 2009 to 2018. The primary outcome was to assess the association between weight loss and renal function in participants undergoing bariatric surgery. Secondary outcomes included changes in hemoglobin A1c, lipids, fasting glucose, and blood pressure. Results Among the 55 participants, baseline glomerular filtration rate (GFR) was 49 mL/min/m2, 80% were female, and the average baseline weight was 131 kg. At one-year post-intervention, 69% of patients improved in the CKD stage, with 45% of the participants improving from stage 3A to stage 2. GFR improved to 15 mL/min/1.73m2 (p = 0.025), and there was a negative correlation (rs = -0.3556) between weight and GFR (p = 0.013). Participants with hyperlipidemia had a 12 mL/min/1.73m2 rise in GFR, while participants without the diagnosis at one year had a 24 mL/min/1.73m2 rise in GFR (p = 0.007). Conclusions This study demonstrated improved renal function and reduced progression of CKD following a combined lifestyle and surgical intervention, indicating the importance of a comprehensive approach for the management of the chronic disease.
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Affiliation(s)
- Oaklee L Abernathy
- Internal Medicine, Kansas University School of Medicine-Wichita, Wichita, USA
| | - Hayrettin Okut
- Preventive Medicine, Kansas University School of Medicine-Wichita, Wichita, USA
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29
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Yim HE, Yoo KH. Obesity and chronic kidney disease: prevalence, mechanism, and management. Clin Exp Pediatr 2021; 64:511-518. [PMID: 33831296 PMCID: PMC8498012 DOI: 10.3345/cep.2021.00108] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/19/2021] [Indexed: 11/27/2022] Open
Abstract
The prevalence of childhood obesity is increasing worldwide at an alarming rate. While obesity is known to increase a variety of cardiovascular and metabolic diseases, it also acts as a risk factor for the development and progression of chronic kidney disease (CKD). During childhood and adolescence, severe obesity is associated with an increased prevalence and incidence of the early stages of kidney disease. Importantly, children born to obese mothers are also at increased risk of developing obesity and CKD later in life. The potential mechanisms underlying the association between obesity and CKD include hemodynamic factors, metabolic effects, and lipid nephrotoxicity. Weight reduction via increased physical activity, caloric restriction, treatment with angiotensin-converting enzyme inhibitors, and judicious bariatric surgery can be used to control obesity and obesity-related kidney disease. Preventive strategies to halt the obesity epidemic in the healthcare community are needed to reduce the widespread deleterious consequences of obesity including CKD development and progression.
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Affiliation(s)
- Hyung Eun Yim
- Department of Pediatrics, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Kee Hwan Yoo
- Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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30
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Shannon CM, Ballew SH, Daya N, Zhou L, Chang AR, Sang Y, Coresh J, Selvin E, Grams ME. Serum albumin and risks of hospitalization and death: Findings from the Atherosclerosis Risk in Communities study. J Am Geriatr Soc 2021; 69:2865-2876. [PMID: 34298583 PMCID: PMC8582595 DOI: 10.1111/jgs.17313] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/15/2021] [Accepted: 05/16/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To determine whether lower serum albumin in community-dwelling, older adults is associated with increased risk of hospitalization and death independent of pre-existing disease. DESIGN Prospective cohort study of participants in the fifth visit of the Atherosclerosis Risk in Communities (ARIC) study. Baseline data were collected from 2011 to 2013. Follow-up was available to December 31, 2017. Replication was performed in Geisinger, a health system in rural Pennsylvania. SETTING For ARIC, four US communities: Washington County, Maryland; Forsyth County, North Carolina; Jackson, Mississippi; and suburbs of Minneapolis, Minnesota. PARTICIPANTS A total of 4947 community-dwelling men and women aged 66 to 90 years. EXPOSURE Serum albumin. MAIN OUTCOMES Incident all-cause hospitalization and death. RESULTS Among the 4947 participants, mean age was 75.5 years (SD: 5.12) and mean baseline serum albumin concentration was 4.05 g/dL (SD: 0.30). Over a median follow-up period of 4.42 years (interquartile interval: 4.16-5.05), 553 participants (11.2%) died and 2457 participants (49.7%) were hospitalized at least once. The total number of hospitalizations was 5725. In analyses adjusted for demographics and numerous clinical characteristics, including tobacco use, obesity, frailty, cardiovascular disease, kidney disease, diabetes C-reactive protein (CRP), cognitive status, alcohol use, medication use, respiratory disease, and systolic blood pressure, 1 g/dL lower baseline serum albumin concentration was associated with higher risk of both hospitalization (incidence rate ratio [IRR]: 1.58; 95% confidence interval [CI]: 1.36-1.82; p < 0.001) and death (hazard ratio [HR]: 1.67; 95% CI: 1.24-2.24; p < 0.001). Associations were weaker with older age but not different by frailty status or level of high-sensitivity CRP. Associations between serum albumin, hospitalizations, and death were also similar in a real-world cohort of primary care patients. CONCLUSIONS Lower baseline serum albumin was significantly associated with increased risk of both all-cause hospitalization and death, independent of pre-existing disease. Older adults with low serum albumin should be considered a high-risk population and targeted for interventions to reduce the risk of adverse outcomes.
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Affiliation(s)
- Colleen M Shannon
- Johns Hopkins Institute for Clinical and Translational Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - Shoshana H Ballew
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - Natalie Daya
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - Linda Zhou
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - Alex R Chang
- Kidney Health Research Institute, Geisinger Health, Danville, Pennsylvania, USA
| | - Yingying Sang
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - Morgan E Grams
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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31
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Morales E, Porrini E, Martin-Taboada M, Luis-Lima S, Vila-Bedmar R, González de Pablos I, Gómez P, Rodríguez E, Torres L, Lanzón B, Rodríguez AE, Maíz M, Medina-Gómez G, Praga M. Renoprotective role of bariatric surgery in patients with established chronic kidney disease. Clin Kidney J 2021; 14:2037-2046. [PMID: 34476090 PMCID: PMC8406062 DOI: 10.1093/ckj/sfaa266] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/23/2020] [Indexed: 12/16/2022] Open
Abstract
Background Bariatric surgery (BS) has been postulated as the most effective measure for weight reduction. Weight loss improves metabolic parameters and exerts changes in renal function that lead to the amelioration of absolute or relative glomerular hyperfiltration, a condition that may be renoprotective in the long term. However, few studies have demonstrated the influence of BS in patients with severe obesity and chronic kidney disease (CKD). Our objective was to analyse the evolution of renal function, adipose tissue–derived molecules and inflammatory parameters in patients with CKD after BS. Methods This is an observational and prospective study. Thirty patients were screened and 12 were included between January 2016 and January 2018 with a 24-month follow-up. Glomerular filtration rate (GFR) was determined by plasma iohexol clearance. Adipokines, cytokines, circulating hormones and fibrotic parameters were evaluated before and 12 months after BS using the Bioplex system. Results The mean age was 50.6 years and 58.3% were males. Seven patients had a body mass index >40 kg/m2 and 66.7% were diabetic. Twenty-four months following BS there was a significant decrease in body weight (36.4%). Proteinuria decreased by 63.7 ± 28.2%. Measured GFR significantly diminished from before surgery to Month 24 after surgery (94 ± 44 to 79 ± 44 mL/min, P = 0.03). There was a significant decrease in adipocyte-derived molecules (leptin and vifastin) as well as in pro-inflammatory cytokines [interleukin (IL)-1β, tumour necrosis factor α, IL-6 and monocyte chemoattractant protein-1] and other circulating factors (vascular endothelial growth factor and transforming growth factor β isoforms). Conclusions BS is an effective option to prevent kidney damage in obese subjects with CKD due to the improvement of glomerular hyperfiltration, adipocyte cytokines metabolic and inflammatory parameters.
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Affiliation(s)
- Enrique Morales
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain.,Investigation Institute of University Hospital, 12 de Octubre , Madrid, Spain
| | - Esteban Porrini
- Faculty of Medicine, Instituto de Tecnologías Biomédicas, University of La Laguna, Laguna, Spain
| | - Marina Martin-Taboada
- Depatment Basic Sciences of Health, Faculty of Sciences of Health, Universidad Rey Juan Carlos, Madrid, Spain
| | - Sergio Luis-Lima
- Department of Nephrology and Hypertension, IIS-Fundación Jimenez Díaz, Madrid, Spain
| | - Rocío Vila-Bedmar
- Depatment Basic Sciences of Health, Faculty of Sciences of Health, Universidad Rey Juan Carlos, Madrid, Spain
| | | | - Pilar Gómez
- Department of Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Elías Rodríguez
- Department of Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Lucia Torres
- Depatment Basic Sciences of Health, Faculty of Sciences of Health, Universidad Rey Juan Carlos, Madrid, Spain
| | - Borja Lanzón
- Depatment Basic Sciences of Health, Faculty of Sciences of Health, Universidad Rey Juan Carlos, Madrid, Spain
| | - Ana Elena Rodríguez
- Fundación General de la ULL, Instituto de Tecnologias Biomédicas, Madrid, Spain
| | - María Maíz
- Department of Endocrinology, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - Gema Medina-Gómez
- Depatment Basic Sciences of Health, Faculty of Sciences of Health, Universidad Rey Juan Carlos, Madrid, Spain
| | - Manuel Praga
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain.,Investigation Institute of University Hospital, 12 de Octubre , Madrid, Spain
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Parvathareddy VP, Ella KM, Shah M, Navaneethan SD. Treatment options for managing obesity in chronic kidney disease. Curr Opin Nephrol Hypertens 2021; 30:516-523. [PMID: 34039849 PMCID: PMC8373688 DOI: 10.1097/mnh.0000000000000727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Obesity is a risk factor for the development and progression of chronic kidney disease (CKD). In this review, we provide a comprehensive overview of various management options (lifestyle intervention, medications, and bariatric surgery) to address obesity in those with CKD. RECENT FINDINGS Few clinical trials have examined the benefits of lifestyle modifications in those with preexisting CKD and suggest potential renal and cardiovascular benefits in this population. Yet, superiority of different dietary regimen to facilitate weight loss in CKD is unclear. Although medications could offer short-term benefits and assist weight loss, their safety and long-term benefits warrant further studies in this high-risk population. Observational studies report that bariatric procedures are associated with lower risk of end stage kidney disease. Clinicians should also recognize the higher risk of acute kidney injury, nephrolithiasis, and other complications noted with bariatric surgical procedures. SUMMARY Lifestyle modifications and some weight loss medications may be recommended for facilitating weight loss in CKD. Referral to bariatric centers should be considered among morbidly obese adults with CKD.
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Affiliation(s)
- Vishnu P Parvathareddy
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | | | - Maulin Shah
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Section of Nephrology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Sankar D. Navaneethan
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Section of Nephrology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
- Institute of Clinical and Translational Research, Baylor College of Medicine, Houston, Texas, USA
- VA Health Services Research and Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX
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Kalantar-Zadeh K, Jafar TH, Nitsch D, Neuen BL, Perkovic V. Chronic kidney disease. Lancet 2021; 398:786-802. [PMID: 34175022 DOI: 10.1016/s0140-6736(21)00519-5] [Citation(s) in RCA: 491] [Impact Index Per Article: 163.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 02/11/2021] [Accepted: 02/19/2021] [Indexed: 12/11/2022]
Abstract
Chronic kidney disease is a progressive disease with no cure and high morbidity and mortality that occurs commonly in the general adult population, especially in people with diabetes and hypertension. Preservation of kidney function can improve outcomes and can be achieved through non-pharmacological strategies (eg, dietary and lifestyle adjustments) and chronic kidney disease-targeted and kidney disease-specific pharmacological interventions. A plant-dominant, low-protein, and low-salt diet might help to mitigate glomerular hyperfiltration and preserve renal function for longer, possibly while also leading to favourable alterations in acid-base homoeostasis and in the gut microbiome. Pharmacotherapies that alter intrarenal haemodynamics (eg, renin-angiotensin-aldosterone pathway modulators and SGLT2 [SLC5A2] inhibitors) can preserve kidney function by reducing intraglomerular pressure independently of blood pressure and glucose control, whereas other novel agents (eg, non-steroidal mineralocorticoid receptor antagonists) might protect the kidney through anti-inflammatory or antifibrotic mechanisms. Some glomerular and cystic kidney diseases might benefit from disease-specific therapies. Managing chronic kidney disease-associated cardiovascular risk, minimising the risk of infection, and preventing acute kidney injury are crucial interventions for these patients, given the high burden of complications, associated morbidity and mortality, and the role of non-conventional risk factors in chronic kidney disease. When renal replacement therapy becomes inevitable, an incremental transition to dialysis can be considered and has been proposed to possibly preserve residual kidney function longer. There are similarities and distinctions between kidney-preserving care and supportive care. Additional studies of dietary and pharmacological interventions and development of innovative strategies are necessary to ensure optimal kidney-preserving care and to achieve greater longevity and better health-related quality of life for these patients.
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Affiliation(s)
- Kamyar Kalantar-Zadeh
- Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine, Orange, CA, USA; Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA, USA.
| | - Tazeen H Jafar
- Duke-NUS Graduate Medical School, Singapore; Department of Renal Medicine, Singapore General Hospital, Singapore; Duke Global Health Institute, Durham, NC, USA
| | - Dorothea Nitsch
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK; United Kingdom Renal Registry, Bristol, UK; Department of Nephrology, Royal Free London NHS Foundation Trust, London, UK
| | - Brendon L Neuen
- The George Institute for Global Health, University of New South Wales Sydney, Sydney, NSW, Australia
| | - Vlado Perkovic
- Faculty of Medicine, University of New South Wales Sydney, Sydney, NSW, Australia
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34
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Extracellular fluid volume: A suitable indexation variable to assess impact of bariatric surgery on glomerular filtration rate in patients with chronic kidney disease. PLoS One 2021; 16:e0256234. [PMID: 34398928 PMCID: PMC8366966 DOI: 10.1371/journal.pone.0256234] [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: 04/06/2021] [Accepted: 08/02/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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). CONCLUSION There is a difference between mGFRBSA and mGFRECFV following BS and the latter might better reflect the adequacy between renal function and corpulence.
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35
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Wong CKH, Wu T, Wong SKH, Law BTT, Grieve E, Ng EKW, Wu O, Lam CLK. Effects of bariatric surgery on kidney diseases, cardiovascular diseases, mortality and severe hypoglycaemia among patients with Type 2 diabetes mellitus. Nephrol Dial Transplant 2021; 36:1440-1451. [PMID: 32591819 DOI: 10.1093/ndt/gfaa075] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Bariatric surgery has been widely indicated for the management of obesity and related comorbidities. However, there are uncertainties pertaining to the risks of post-bariatric severe hypoglycaemia (SH), cardiovascular diseases (CVDs), end-stage kidney diseases (ESKDs) and all-cause mortality in obese patients with Type 2 diabetes mellitus (T2DM), especially among Asian populations. METHODS A retrospective population-based cohort of 1702 obese T2DM patients who were free of CVD and ESKD were assembled based on the 2006-17 Hospital Authority database. One-to-five propensity-score matching was used to balance baseline covariates between patients in bariatric surgery and control groups. Incidence rates (IRs) of SH, CVD, Stage 4/5 chronic kidney diseases (CKD), ESKD and all-cause mortality events for two groups were calculated. Hazard ratios (HR) for SH, CVD and Stage 4/5 CKD events were assessed using Cox-proportional hazard models. Changes in estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (UACR) were measured up to 60 months. RESULTS Over a mean follow-up period of 32 months with 5725 person-years, cumulative incidences of mortality, CVD, Stage 4/5 CKD, ESKD and SH were 0, 0.036, 0.050, 0.017 and 0.020, respectively. The surgery group had a significant reduction in risk of CVD events (HR = 0.464, P = 0.015) and no occurrence of mortality events. However, there were no significant differences in risks of SH [HR = 0.469, 95% confidence interval (CI): 0.204-1.081], Stage 4/5 CKD (HR =0.896, 95% CI: 0.519-1.545) and ESKD (HR = 0.666, 95% CI: 0.264-1.683) between two groups, although IRs were lower in the surgery group. Surgical patients had significantly higher eGFR within 12 months and had significantly lower UACR until 48 months. CONCLUSIONS Among obese T2DM patients, bariatric surgery lowered the risk of CVD and mortality, and was beneficial towards the kidney outcomes.
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Affiliation(s)
- Carlos K H Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| | - Tingting Wu
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
| | - Simon K H Wong
- Department of Surgery, Prince of Wales Hospital, Hong Kong SAR, China.,Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Betty T T Law
- Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, The University of Hong Kong, Hong Kong SAR, China
| | - Eleanor Grieve
- Health Economics and Health Technology Assessment, Institute of Health & Well-Being, University of Glasgow, Glasgow, UK
| | - Enders K W Ng
- Department of Surgery, Prince of Wales Hospital, Hong Kong SAR, China.,Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Olivia Wu
- Health Economics and Health Technology Assessment, Institute of Health & Well-Being, University of Glasgow, Glasgow, UK
| | - Cindy L K Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China
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36
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Koh ES, Han KD, Kim MK, Kim ES, Lee MK, Nam GE, Kwon HS. Weight change and microvascular outcomes in patients with new-onset diabetes: a nationwide cohort study. Korean J Intern Med 2021; 36:932-941. [PMID: 32872746 PMCID: PMC8273818 DOI: 10.3904/kjim.2020.121] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/13/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND/AIMS Because weight control is important in treatment of type 2 diabetes, it is essential to understand the associations between weight change and the risk of microvascular complications among patients with type 2 diabetes. We examined whether weight changes early after new-onset diabetes have an impact on the clinical outcomes of diabetic nephropathy and retinopathy. METHODS Using the Korean National Health Insurance Service-National Health Screening Cohort database, 181,872 patients newly diagnosed with type 2 diabetes who were free of end-stage renal disease (ESRD) and proliferative diabetic retinopathy (PDR) during 2007 to 2012 were followed to the end of 2016. Weight change was defined as the difference in body weight from the time of diabetes diagnosis to 2 years later. RESULTS We identified 180 cases of ESRD and 780 cases of PDR followed up for a median of 5.5 years from the index year at 2 years after diagnosis. Those with 5% to 10% weight gain showed a significantly higher hazard ratio (HR) for ESRD, compared with those with ≤ 5% weight change after adjusting for several confounding factors, including the baseline estimated glomerular filtration rate (HR, 1.75; 95% confidence interval [CI], 1.14 to 2.70). Those with ≥ 10% weight loss showed the lowest HR for PDR (HR, 0.52; 95% CI, 0.33 to 0.83), whereas those with ≥ 10% weight gain showed the highest HR for PDR (HR, 3.20; 95% CI, 2.51 to 4.08). CONCLUSION Weight gain after new-onset diabetes was associated with increased risk of ESRD and PDR whereas weight loss with decreased risk of PDR, but not ESRD.
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Affiliation(s)
- Eun Sil Koh
- Division of Nephrology, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Cell Death Disease research Center, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Kyung Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul,
Korea
| | - Mee Kyoung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Eun Sook Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon,
Korea
| | - Min-Kyung Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang,
Korea
| | - Ga Eun Nam
- Department of Family Medicine, Korea University Anam Hospital, Seoul,
Korea
| | - Hyuk-Sang Kwon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
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37
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Malik AT, Noria S, Xu W, Retchin S, Yu ES, Khan SN. Bariatric Surgery Before Elective Anterior Cervical Discectomy and Fusion (ACDF) in Obese Patients Is Associated With Reduced Risk of 90-Day Postoperative Complications and Readmissions. Clin Spine Surg 2021; 34:171-175. [PMID: 33290330 DOI: 10.1097/bsd.0000000000001120] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 11/07/2020] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN This was a national database study. OBJECTIVE The objective of this study was to assess the impact of prior bariatric surgery (BS) on altering 90-day postoperative outcomes following elective anterior cervical discectomy and fusions (ACDFs). SUMMARY OF BACKGROUND DATA Though obesity has previously been shown to be linked with adverse outcomes following elective spine surgical procedures, the effectiveness of weight-loss strategies such as BS has not been explored. METHODS The PearlDiver program was used to query the 2007-2013 100% Medicare Standard Analytical Files (SAF100) for patients undergoing an elective ACDF. The study cohort was divided into 2 groups-(1) obese ACDF patients (body mass index ≥35 kg/m 2 ) receiving a BS procedure within 2 years before an ACDF and (2) obese ACDF patients (body mass index ≥35 kg/m 2 ) without a known history of a BS procedure within the last 2 years. Multivariate regression analyses were used to assess the impact of a BS procedure on postoperative outcomes following ACDF while adjusting for age, sex, region, and Elixhauser Comorbidity Index. RESULTS A total of 411 ACDF patients underwent BS within the 2 years before an ACDF. Multivariate analysis showed that undergoing BS before an elective ACDF was associated with a significantly reduced risk of pulmonary complications [odds ratio (OR)=0.53; P =0.002], cardiac complications (OR=0.69; P =0.012), sepsis (OR=0.69; P =0.035), renal complications (OR=0.54; P =0.044), and 90-day readmissions (OR=0.53; P =0.015). CONCLUSIONS Surgery-induced weight loss before an ACDF in obese patients is associated with reduced 90-day complication and readmission rates. Orthopaedic and bariatric surgeons should counsel obese patients on the benefits of BS following ACDFs.
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Affiliation(s)
| | - Sabrena Noria
- Department of Surgery, Division of General and GI Surgery, The Ohio State University Wexner Medical Center
| | - Wendy Xu
- College of Public Health, The Ohio State University, Columbus, OH
| | - Sheldon Retchin
- College of Public Health, The Ohio State University, Columbus, OH
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Friedman AN, Kaplan LM, le Roux CW, Schauer PR. Management of Obesity in Adults with CKD. J Am Soc Nephrol 2021; 32:777-790. [PMID: 33602674 PMCID: PMC8017542 DOI: 10.1681/asn.2020101472] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Obesity is a leading public health problem that currently affects over 650 million individuals worldwide. Although interest in the adverse effects of obesity has grown exponentially in recent years, less attention has been given to studying its management in individuals with CKD. This relatively unexplored area should be considered a high priority because of the rapid growth and high prevalence of obesity in the CKD population, its broad impact on health and outcomes, and its modifiable nature. This article begins to lay the groundwork in this field by providing a comprehensive overview that critically evaluates the available evidence related to obesity and kidney disease, identifies important gaps in our knowledge base, and integrates recent insights in the pathophysiology of obesity to help provide a way forward in establishing guidelines as a basis for managing obesity in CKD. Finally, the article includes a kidney-centric algorithm for management of obesity that can be used in clinical practice.
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Affiliation(s)
- Allon N. Friedman
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Lee M. Kaplan
- Obesity, Metabolism, and Nutrition Institute, Massachusetts General Hospital, Boston, Massachusetts
| | - Carel W. le Roux
- Diabetes Complications Research Center, University College Dublin, Dublin, Ireland
| | - Philip R. Schauer
- Pennington Biomedical Research Institute, Louisiana State University, Baton Rouge, Louisiana
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39
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Abstract
Obesity has a fundamental role in driving the global kidney disease burden. The perplexing relationship of obesity with chronic kidney disease remains debated. However, a thorough understanding of the interplay of obesity in conjunction with chronic kidney disease and appropriate management options is lacking, leading to further increases in morbidity and mortality. Moreover, underutilization of bariatric procedures and unrealistic expectations of weight reduction based on body mass index, leading to poor access to kidney transplantation, are fueling the fire. In this review, we summarize the available data related to the obesity and chronic kidney disease association and its novel management options.
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40
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Chintam K, Chang AR. Strategies to Treat Obesity in Patients With CKD. Am J Kidney Dis 2021; 77:427-439. [PMID: 33075388 PMCID: PMC7904606 DOI: 10.1053/j.ajkd.2020.08.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/11/2020] [Indexed: 12/17/2022]
Abstract
Obesity prevalence continues to increase worldwide, accompanied by a rising tide of hypertension, diabetes, and chronic kidney disease (CKD). Although body mass index is typically used to assess obesity in clinical practice, altered body composition (eg, reduced muscle mass and increased visceral adiposity) are common among patients with CKD. Weight loss achieved through behavioral modification or medications reduces albuminuria and in some cases slows the decline in estimated glomerular filtration rate. Use of medications that promote weight loss with favorable cardiovascular risk profiles should be promoted, particularly in patients with type 2 diabetes, obesity, and CKD. For those who fail to achieve weight loss through lifestyle modification, bariatric surgery should be considered because observational studies have shown reductions in risk for estimated glomerular filtration rate decline and kidney failure. Uncertainty persists on the risk to benefit ratio of intentional weight loss in patients with kidney failure due to the lack of prospective trials and limitations of observational data. Regardless, sleeve gastrectomy is increasingly being used for patients with kidney failure and severe obesity, with success in achieving sustained weight loss, improved access to kidney transplantation, and favorable posttransplantation outcomes. More research is needed assessing long-term cardiovascular and kidney outcomes of most weight loss medications.
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Affiliation(s)
| | - Alex R Chang
- Department of Population of Health Sciences, Geisinger, Danville, PA; Kidney Health Research Institute, Geisinger, Danville, PA; Department of Nephrology, Geisinger, Danville, PA.
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41
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Mahmoudieh M, Keleidari B, Hadipour P, Sheikhbahaei E, Chang AR, Ramtin S, Shahabi S. Comparative Effectiveness of Roux-en-Y Gastric Bypass vs. One Anastomosis Gastric Bypass on Kidney Function. Obes Surg 2021; 31:2464-2470. [PMID: 33599924 DOI: 10.1007/s11695-021-05295-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Obesity and its associated medical problems increase risk of kidney function decline while prior studies suggest that bariatric surgery may improve kidney outcomes. However, little is known about the comparative effectiveness of different types of bariatric surgery on kidney function. In this study, we compare the effects of laparoscopic one anastomosis gastric bypass (LOAGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB) on kidney function one year after surgery. MATERIALS AND METHODS The patients' demographic, medical, and surgical data were prospectively collected and retrospectively reviewed. Type 2 diabetes mellitus, hypertension, and dyslipidemia, body mass index (BMI), and kidney function tests were obtained before and one year after surgery. Kidney function was evaluated by estimated glomerular filtration rate (eGFR) and spot urine albumin to creatinine ratio (ACR). Changes in eGFR and ACR were compared between LRYGB vs. LOAGB after adjustment for confounders (age, sex, remission of associated medical problems, preoperative BMI, and percentage of excess BMI loss) using ANCOVA model. RESULTS Both surgical techniques significantly decreased the post-surgery presence of diabetes, hypertension, and dyslipidemia (p < 0.001 for all paired comparisons). The eGFR level significantly increased and the ACR level significantly decreased in both groups (p < 0.001 for all paired comparisons before and after adjustment). However, eGFR and ACR mean differences between LRYGB and LOAGB were not significantly different after adjustment for confounding variables (p = 0.9 and 0.4, respectively). CONCLUSION Both LOAGB and LRYGB improved 1-year eGFR and ACR equally independently from weight loss and other confounders.
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Affiliation(s)
- Mohsen Mahmoudieh
- Department of Surgery, Isfahan Minimally Invasive Surgery and Obesity Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Behrouz Keleidari
- Department of Surgery, Isfahan Minimally Invasive Surgery and Obesity Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Pedram Hadipour
- Department of Surgery, Isfahan Minimally Invasive Surgery and Obesity Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Erfan Sheikhbahaei
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Alex R Chang
- Kidney Health Research Institute, Geisinger Health, Danville, Philadelphia, PA, USA
| | - Sina Ramtin
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahab Shahabi
- Department of Surgery, Isfahan Minimally Invasive Surgery and Obesity Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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42
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Qin S, Wang A, Gu S, Wang W, Gao Z, Tang X, Yan L, Wan Q, Luo Z, Qin G, Chen L, Ning G, Mu Y. Association between obesity and urinary albumin-creatinine ratio in the middle-aged and elderly population of Southern and Northern China: a cross-sectional study. BMJ Open 2021; 11:e040214. [PMID: 33402405 PMCID: PMC7786798 DOI: 10.1136/bmjopen-2020-040214] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE The relationship between obesity and albuminuria has not been clarified. This study aimed to investigate the correlation between obesity and the urinary albumin-creatinine ratio (UACR) in Southern and Northern China. DESIGN A descriptive, cross-sectional study. SETTING Eight regional centres in REACTION (China's Risk Evaluation of cAncers in Chinese diabeTic Individuals, a lONgitudinal study), including Dalian, Lanzhou, Zhengzhou, Guangzhou, Guangxi, Luzhou, Shanghai and Wuhan. PARTICIPANTS A total of 41 085 patients who were not diagnosed with chronic kidney disease (CKD) and had good compliance were selected according to the inclusion criteria. Patients who were diagnosed with CKD, who had other kidney diseases that could lead to increased urinary protein excretion, who were using angiotensin-converting-enzyme inhibitors or angiotensin II receptor blockers and whose important data were missing were excluded. RESULTS Participants with both, central and peripheral obesity, had a higher risk of elevated UACR, even after adjusting for multiple factors (OR: 1.14, 95% CI: 1.07 to 1.12, p<0.001), and the risk of high UACR in the South was more prominent than that in the North (OR South: 1.22, 95% CI: 1.11 to 1.34; OR North: 1.13, 95% CI: 1.04 to 1.22, p<0.001). The risk was also elevated in the male population, hypertensive individuals, glycosylated haemoglobin (HbA1c)≥6.5% and age ≥60 years in the South. Besides the above groups, diabetes was also a risk factor for the Northern population. CONCLUSIONS In China, people with both central and peripheral obesity are prone to a high UACR, and the southern population has a higher risk than northern population. Factors such as male sex, hypertension, HbA1c≥6.5% and an age ≥60 years are also risk factors for CKD.
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Affiliation(s)
- Shan Qin
- Department of Endocrinology, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Anping Wang
- Department of Endocrinology, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Shi Gu
- School of Medicine, Nankai University, Tianjin, China
| | - Weiqing Wang
- Department of Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Zhengnan Gao
- Department of Endocrinology, Dalian Municipal Central Hospital, Dalian, Liaoning, China
| | - Xulei Tang
- Department of Endocrinology, First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Li Yan
- Department of Endocrinology, Sun Yat‑sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qin Wan
- Department of Endocrinology, Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan, China
| | - Zuojie Luo
- Department of Endocrinology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Guijun Qin
- Department of Endocrinology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Lulu Chen
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Guang Ning
- Department of Endocrine and Metabolic Diseases, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Yiming Mu
- Department of Endocrinology, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
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Chang AR, George J, Levey AS, Coresh J, Grams ME, Inker LA. Performance of Glomerular Filtration Rate Estimating Equations Before and After Bariatric Surgery. Kidney Med 2020; 2:699-706.e1. [PMID: 33319195 PMCID: PMC7729215 DOI: 10.1016/j.xkme.2020.08.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Rationale & Objective Evaluation of glomerular filtration rate (GFR) is challenging in adults undergoing bariatric surgery because creatinine and cystatin C levels are influenced by changes in muscle and fat mass. Additionally, indexing of GFR by body surface area (BSA) may by affected by decreases in BSA. Study Design Prospective observational study. Setting & Participants 27 adults with body mass index (BMI) ≥ 35 kg/m2 who underwent measurement of GFR before and after bariatric surgery. Outcomes Indexed and nonindexed GFRs measured (mGFRs) using plasma iohexol clearance, indexed and nonindexed estimated GFR (eGFR) based on levels of creatinine, cystatin C, or both from Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. Analytic Approach Bias and percent of estimates within 20% and 30% of mGFR (P20 and P30) for estimating equations were examined. Results Mean presurgery BMI was 49.5 (SD, 9.4) kg/m2, BSA was 2.42 (SD, 0.27) m2, nonindexed mGFR was 117.3 (SD, 34.1) mL/min, and indexed mGFR was 84.1 (SD, 22.0) mL/min/1.73 m2. After 6 months, mean BMI changed by –13.8 (95% CI, −15.9 to −11.8) kg/m2, BSA by −0.30 (95% CI, −0.33 to −0.27) m2, and nonindexed mGFR by −9.2 (95% CI, −17.2 to −1.1) mL/min, while indexed mGFR was unchanged at 5.1 (95% CI, −0.1 to 10.4) mL/min/1.73 m2. Nonindexed eGFRcr was unbiased (median bias, 5.0 [95% CI, −4.3 to 11.6] mL/min) before surgery, but overestimated mGFR (8.8 [95% CI, 1.8 to 16.9] mL/min) after surgery. Nonindexed eGFRcys underestimated mGFR before (median bias, −12.1 [95% CI, −21.4 to −1.2] mL/min) and after surgery (−11.2 [95% CI, −21.8 to −7.3] mL/min). Nonindexed eGFRcr-cys was unbiased before (median bias, −6.0 [95% CI, −11.0 to 1.0] mL/min) and after surgery (−2.0 [95% CI, −8.8 to 4.9] mL/min). Findings were similar for indexed eGFR compared with indexed mGFR. Limitations Small, mostly white sample. Conclusions Changes in indexed and nonindexed GFRs may be discordant after bariatric surgery in adults because of decreases in BSA. Indexed and nonindexed eGFRcr-cys may be less biased than indexed or nonindexed eGFRcr or eGFRcys because of opposite biases in estimating mGFR.
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Affiliation(s)
- Alex R. Chang
- Kidney Health Research Institute, Geisinger, Danville, PA
- Department of Population Health Sciences, Geisinger, Danville, PA
- Address for Correspondence: Alex R. Chang, MD, MS, 100 N Academy Ave, Danville, PA 17822.
| | - Jason George
- Department of Population Health Sciences, Geisinger, Danville, PA
| | | | - Josef Coresh
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD
- Divison of Nephrology, Johns Hopkins University, Baltimore, MD
| | - Morgan E. Grams
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD
- Divison of Nephrology, Johns Hopkins University, Baltimore, MD
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Seo M, Kim H, Noh H, Jeon JS, Byun DW, Kim SH, Kim HJ, Suh K, Park HK, Kwon SH. Effect of bariatric surgery on circulating and urinary mitochondrial DNA copy numbers in obesity with or without diabetes. BMJ Open Diabetes Res Care 2020; 8:8/1/e001372. [PMID: 33020132 PMCID: PMC7536782 DOI: 10.1136/bmjdrc-2020-001372] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/22/2020] [Accepted: 08/23/2020] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Recent studies have suggested that extracellular circulating and urinary mitochondrial DNA (mtDNA) are associated with mitochondrial dysfunction in obesity and type 2 diabetes mellitus (T2DM). However, the changes to cell-free serum and urinary mtDNA after bariatric surgery in patients with obesity with T2DM have not been investigated to date. RESEARCH DESIGN AND METHODS We prospectively recruited patients with obesity (n=18), and with obesity and T2DM (n=14) who underwent bariatric surgery, along with healthy volunteers (HV) as a control group (n=22). Serum and urinary mitochondrial nicotinamide adenine dinucleotide dehydrogenase subunit-1 (mtND-1) and cytochrome-c oxidase 3 (mtCOX-3) copy numbers were measured using quantitative PCR (qPCR). The mtDNA copy numbers of patients with obesity (with and without T2DM) were followed up 6 months after surgery. RESULTS The copy numbers of urinary mtND-1 and mtCOX-3 in patients with obesity, with or without T2DM, were higher than those in the HVs. Moreover, urinary mtCOX-3 copy number increased in patients with obesity with T2DM compared with patients with obesity without T2DM (p=0.018). Meanwhile, serum mtCOX-3 copy numbers in HV were higher in both obesity patient groups (p=0.040). Bariatric surgery reduced urinary mtND-1 and mtCOX-3 copy numbers, as well as serum mtCOX-3 copy numbers only in patients with obesity with T2DM. CONCLUSION These results suggest that T2DM induces greater kidney mitochondrial dysfunction in patients with obesity, which can be effectively restored with bariatric surgery.
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Affiliation(s)
- Mihae Seo
- Internal Medicine, Soonchunhyang University Hospital, Gumi, Gyeongsangbuk-do, The Republic of Korea
| | - Hyoungnae Kim
- Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, The Republic of Korea
- Hyaonam Kidney Laboratory, Soonchunhyang University Seoul Hospital, Seoul, The Republic of Korea
| | - Hyunjin Noh
- Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, The Republic of Korea
- Hyaonam Kidney Laboratory, Soonchunhyang University Seoul Hospital, Seoul, The Republic of Korea
| | - Jin Seok Jeon
- Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, The Republic of Korea
- Hyaonam Kidney Laboratory, Soonchunhyang University Seoul Hospital, Seoul, The Republic of Korea
| | - Dong Won Byun
- Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, The Republic of Korea
| | - Sang Hyun Kim
- Department of Surgery, Soonchunhyang University Seoul Hospital, Seoul, The Republic of Korea
| | - Hye Jeong Kim
- Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, The Republic of Korea
| | - Kyoil Suh
- Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, The Republic of Korea
| | - Hyeong Kyu Park
- Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, The Republic of Korea
| | - Soon Hyo Kwon
- Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, The Republic of Korea
- Hyaonam Kidney Laboratory, Soonchunhyang University Seoul Hospital, Seoul, The Republic of Korea
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Chang AR, Wood GC, Chu X, Surapaneni A, Grams ME. Association of Bariatric Surgery With Rates of Kidney Function Decline Using Multiple Filtration Markers. JAMA Netw Open 2020; 3:e2014670. [PMID: 32886117 PMCID: PMC7489865 DOI: 10.1001/jamanetworkopen.2020.14670] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This cohort study examines the association of bariatric surgery with rates of kidney function decline.
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Affiliation(s)
- Alex R. Chang
- Kidney Health Research Institute, Geisinger, Danville, Pennsylvania
- Department of Population Health Sciences, Geisinger, Danville, Pennsylvania
| | - G. Craig Wood
- Obesity Institute, Geisinger, Danville, Pennsylvania
| | - Xin Chu
- Obesity Institute, Geisinger, Danville, Pennsylvania
| | - Aditya Surapaneni
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Morgan E. Grams
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Divison of Nephrology, Johns Hopkins University, Baltimore, Maryland
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46
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Pazos F. Range of adiposity and cardiorenal syndrome. World J Diabetes 2020; 11:322-350. [PMID: 32864046 PMCID: PMC7438185 DOI: 10.4239/wjd.v11.i8.322] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/27/2020] [Accepted: 06/14/2020] [Indexed: 02/05/2023] Open
Abstract
Obesity and obesity-related co-morbidities, diabetes mellitus, and hypertension are among the fastest-growing risk factors of heart failure and kidney disease worldwide. Obesity, which is not a unitary concept, or a static process, ranges from alterations in distribution to the amount of adiposity. Visceral adiposity, which includes intraabdominal visceral fat mass and ectopic fat deposition such as hepatic, cardiac, or renal, was robustly associated with a greater risk for cardiorenal morbidity than subcutaneous adiposity. In addition, morbid obesity has also demonstrated a negative effect on cardiac and renal functioning. The mechanisms by which adipose tissue is linked with the cardiorenal syndrome (CRS) are hemodynamic and mechanical changes, as well neurohumoral pathways such as insulin resistance, endothelial dysfunction, nitric oxide bioavailability, renin-angiotensin-aldosterone, oxidative stress, sympathetic nervous systems, natriuretic peptides, adipokines and inflammation. Adiposity and other associated co-morbidities induce adverse cardiac remodeling and interstitial fibrosis. Heart failure with preserved ejection fraction has been associated with obesity-related functional and structural abnormalities. Obesity might also impair kidney function through hyperfiltration, increased glomerular capillary wall tension, and podocyte dysfunction, which leads to tubulointerstitial fibrosis and loss of nephrons and, finally, chronic kidney disease. The development of new treatments with renal and cardiac effects in the context of type 2 diabetes, which improves mortality outcome, has highlighted the importance of CRS and its prevalence. Increased body fat triggers cellular, neuro-humoral and metabolic pathways, which create a phenotype of the CRS with specific cellular and biochemical biomarkers. Obesity has become a single cardiorenal umbrella or type of cardiorenal metabolic syndrome. This review article provides a clinical overview of the available data on the relationship between a range of adiposity and CRS, the support for obesity as a single cardiorenal umbrella, and the most relevant studies on the recent therapeutic approaches.
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Affiliation(s)
- Fernando Pazos
- Department of Medicine, Medicine Faculty, Cantabria University, Valdecilla Hospital, Santander 39080, Cantabria, Spain
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47
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Głuszek S, Bociek A, Suliga E, Matykiewicz J, Kołomańska M, Bryk P, Znamirowski P, Nawacki Ł, Głuszek-Osuch M, Wawrzycka I, Kozieł D. The Effect of Bariatric Surgery on Weight Loss and Metabolic Changes in Adults with Obesity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155342. [PMID: 32722225 PMCID: PMC7432000 DOI: 10.3390/ijerph17155342] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/16/2020] [Accepted: 07/21/2020] [Indexed: 12/15/2022]
Abstract
Methods of treating obesity, such as changes in lifestyle, physical activity, restrictive diets, and psychotherapy, are not sufficient. Currently, it is considered that in the case of patients who meet the eligibility criteria for surgery, the treatment of choice should be bariatric surgery. The aim of this study was to assess the weight loss and metabolic changes in a group of adults with obesity undergoing bariatric surgery. The study involved 163 patients whose body mass index (BMI) exceeded 40 or 35 kg/m2, concurrent with at least one metabolic sequelae. In 120 of the cases (74%), sleeve gastrectomy was used; in 35 (21%), gastric banding was used; and in 8 (5%), laparoscopic Roux-en-Y gastric bypass was used. Metabolic parameters such as total cholesterol, LDL-cholesterol (low-density lipoprotein cholesterol), HDL-cholesterol (high-density lipoprotein cholesterol), triglycerides, and glucose were measured preoperatively and postoperatively, as well as the creatinine, creatine kinase (CK-MB), and leptin activity. In patients undergoing bariatric surgery, a significant decrease in excess weight (p < 0.001) was observed at all the analyzed time points, compared to the pre-surgery value. Weight loss after surgery was associated with a significant improvement in glycemia (109.6 ± 48.0 vs. 86.6 ± 7.9 mg/dL >24 months after surgery; p = 0.003), triglycerides (156.9 ± 79.6 vs. 112.7 ± 44.3 mg/dL >24 months after surgery; p = 0.043) and leptin (197.50 ± 257.3 vs. 75.98 ± 117.7 pg/mL 12 months after surgery; p = 0.0116) concentration. The results of the research confirm the thesis on the effectiveness of bariatric surgery in reducing excess body weight and improving metabolic parameters in patients with extreme obesity.
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Affiliation(s)
- Stanisław Głuszek
- The Institute of Medical Sciences, Medical College, Jan Kochanowski University, 25-369 Kielce, Poland; (S.G.); (J.M.); (M.K.); (P.B.); (Ł.N.); (I.W.)
- Clinic of General, Oncological and Endocrinological Surgery, Provincial Hospital in Kielce, 25-736 Kielce, Poland;
| | - Arkadiusz Bociek
- The Institute of Medical Sciences, Medical College, Jan Kochanowski University, 25-369 Kielce, Poland; (S.G.); (J.M.); (M.K.); (P.B.); (Ł.N.); (I.W.)
- Correspondence: ; Tel.: +48-41-349-69-11
| | - Edyta Suliga
- The Institute of Health Sciences, Medical College, Jan Kochanowski University, 25-369 Kielce, Poland; (E.S.); (M.G.-O.); (D.K.)
| | - Jarosław Matykiewicz
- The Institute of Medical Sciences, Medical College, Jan Kochanowski University, 25-369 Kielce, Poland; (S.G.); (J.M.); (M.K.); (P.B.); (Ł.N.); (I.W.)
- Clinic of Oncological Surgery of the Swiętokrzyskie Center of Oncology in Kielce, 25-734 Kielce, Poland
| | - Magdalena Kołomańska
- The Institute of Medical Sciences, Medical College, Jan Kochanowski University, 25-369 Kielce, Poland; (S.G.); (J.M.); (M.K.); (P.B.); (Ł.N.); (I.W.)
- Clinic of General, Oncological and Endocrinological Surgery, Provincial Hospital in Kielce, 25-736 Kielce, Poland;
| | - Piotr Bryk
- The Institute of Medical Sciences, Medical College, Jan Kochanowski University, 25-369 Kielce, Poland; (S.G.); (J.M.); (M.K.); (P.B.); (Ł.N.); (I.W.)
- Clinic of General, Oncological and Endocrinological Surgery, Provincial Hospital in Kielce, 25-736 Kielce, Poland;
| | - Przemysław Znamirowski
- Clinic of General, Oncological and Endocrinological Surgery, Provincial Hospital in Kielce, 25-736 Kielce, Poland;
| | - Łukasz Nawacki
- The Institute of Medical Sciences, Medical College, Jan Kochanowski University, 25-369 Kielce, Poland; (S.G.); (J.M.); (M.K.); (P.B.); (Ł.N.); (I.W.)
- Clinic of General, Oncological and Endocrinological Surgery, Provincial Hospital in Kielce, 25-736 Kielce, Poland;
| | - Martyna Głuszek-Osuch
- The Institute of Health Sciences, Medical College, Jan Kochanowski University, 25-369 Kielce, Poland; (E.S.); (M.G.-O.); (D.K.)
| | - Iwona Wawrzycka
- The Institute of Medical Sciences, Medical College, Jan Kochanowski University, 25-369 Kielce, Poland; (S.G.); (J.M.); (M.K.); (P.B.); (Ł.N.); (I.W.)
- Clinic of General, Oncological and Endocrinological Surgery, Provincial Hospital in Kielce, 25-736 Kielce, Poland;
| | - Dorota Kozieł
- The Institute of Health Sciences, Medical College, Jan Kochanowski University, 25-369 Kielce, Poland; (E.S.); (M.G.-O.); (D.K.)
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Chang YC, Chao SH, Chen CC, Ser KH, Chong K, Lu CH, Hsieh ML, Huang YY, Lee YC, Hsu CC, Chuang LM, Lee WJ. The Effects of Bariatric Surgery on Renal, Neurological, and Ophthalmic Complications in Patients with Type 2 Diabetes: the Taiwan Diabesity Study. Obes Surg 2020; 31:117-126. [PMID: 32683637 PMCID: PMC7808993 DOI: 10.1007/s11695-020-04859-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/09/2020] [Accepted: 07/11/2020] [Indexed: 12/13/2022]
Abstract
Background Bariatric surgery has been shown to improve glycemic control in patients with type 2 diabetes. However, less is known whether it can also reduce diabetic renal, neurological, and ophthalmic complications. Methods This prospective multicenter cohort study compared renal, ophthalmic, and neurological complications between 49 patients with obesity/overweight receiving bariatric surgery and 338 patients receiving standard medical treatment after follow-up for 2 years. Patients received neurological examinations including toe tuning fork vibration test, ankle tendon reflex test, 10-g monofilament test, and ophthalmic examinations including visual acuity measurement and fundus examinations. Multiple regressions, propensity score weighting, and matching were employed to adjust for baseline differences. Results After 2 years of follow-up, patients with type 2 diabetes receiving bariatric surgery had greater reduction in BMI, HbA1c, and urine albumin–creatinine ratio, greater improvement in estimated glomerular filtration rate, and greater increase in tuning fork test score of right and left toes compared with the medical group. However, there is no improvement in 10 g-monofilament test, visual acuity, diabetic non-proliferative retinopathy, and proliferative retinopathy. Similar results were obtained using multiple regression adjustment, propensity-score weighting, or comparing age-, sex-, and BMI-matched subjects. Conclusions After 2-year follow-up, patients with obesity/overweight and type 2 diabetes receiving bariatric surgery have increased glomerular filtration rate, reduced albuminuria, and improved tuning folk vibration sensation. Electronic supplementary material The online version of this article (10.1007/s11695-020-04859-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yi-Cheng Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Medical Genomics and Proteomics, National Taiwan University, Taipei, Taiwan.,Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Seh-Huang Chao
- Division of General Surgery, Jen-Ai Hospital, Taichung, Taiwan
| | - Ching-Chu Chen
- Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital, Taichung, Taiwan.,School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Kong-Han Ser
- Department of Surgery, Ten-Chen General Hospital, Taoyuan, Taiwan
| | - Keong Chong
- Department of Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan
| | - Chieh-Hsiang Lu
- Division of Metabolism & Endocrinology, Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Meng-Lun Hsieh
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Medical Genomics and Proteomics, National Taiwan University, Taipei, Taiwan
| | - Yu-Yao Huang
- Division of Metabolism & Endocrinology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Chih Lee
- Department of International Business, Chien Hsin University of Science and Technology, Taoyuan, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Lee-Ming Chuang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. .,Graduate Institute of Molecular Medicine, National Taiwan University, Taipei, Taiwan.
| | - Wei-Jei Lee
- Division of General Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan. .,Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
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49
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The Effect of Bariatric Surgery on Patients with Chronic Kidney Disease. Obes Surg 2020; 30:4665-4668. [DOI: 10.1007/s11695-020-04812-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/22/2020] [Accepted: 06/22/2020] [Indexed: 11/26/2022]
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50
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Park S, Lee S, Kim Y, Lee Y, Kang MW, Han K, Lee H, Lee JP, Joo KW, Lim CS, Kim YS, Kim DK. Reduced risk for chronic kidney disease after recovery from metabolic syndrome: A nationwide population-based study. Kidney Res Clin Pract 2020; 39:180-191. [PMID: 32344501 PMCID: PMC7321670 DOI: 10.23876/j.krcp.20.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/13/2020] [Accepted: 03/15/2020] [Indexed: 11/17/2022] Open
Abstract
Background Metabolic syndrome (MetS) is linked to various chronic comorbidities, including chronic kidney disease (CKD). However, few large studies have addressed whether recovery from MetS is associated with reduction in the risks of such comorbidities. Methods This nationwide population-based study in Korea screened 10,664,268 people who received national health screening ≥ 3 times between 2012 and 2016. Those with a history of major cardiovascular events or preexisting CKD were excluded. We classified study groups into four, according to the course of MetS state, as defined by the harmonizing criteria. The main study outcome was incidental CKD (estimated glomerular filtration rate < 60 mL/min/1.73 m2 which was persistent until the last health exams). The study outcomes were investigated using multivariable logistic regression analysis, which was adjusted for clinical variables and the previous severity of MetS. Results Four study groups included 6,315,301 subjects: 4,537,869 people without MetS, 1,034,605 with chronic MetS, 438,287 who developed MetS, and 304,540 who recovered from preexisting MetS. Those who developed MetS demonstrated higher risk of CKD (adjusted odds ratio [OR], 1.26 [1.23-1.29]) than did those who did not develop MetS. In contrast, MetS-recovery was associated with decreased risk of CKD (adjusted OR, 0.84 [0.82-0.86]) than that in people with chronic MetS. Among the MetS components, change in hypertension was associated with the largest difference in CKD risk. Conclusion Reducing or preventing MetS may reduce the burden of CKD on a population-scale. Clinicians should consider the clinical importance of altering MetS status for risk of CKD.
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Affiliation(s)
- Sehoon Park
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Republic of Korea
| | - Soojin Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yaerim Kim
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Yeonhee Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Min Woo Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Kidney Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Kidney Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Kidney Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Yon Su Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Kidney Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Kidney Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
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