Improvement and stabilization of chronic kidney disease after gastric bypass

Alexander, J. Wesley; Goodman, Hope R.; Hawver, Lisa R. Martin; Cardi, M.

doi:10.1016/j.soard.2008.08.016

Cited by 84 publications

(40 citation statements)

References 20 publications

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“…Another study reports a significant improvement in renal parameters after bariatric surgery. 74 Alexander et al 82 reported that, in a series of 45 CKD patients who had undergone gastric bypass, nine patients had resolution, improvement, or stabilization of their kidney function. A study of 233 severely obese patients before and 12 months after bariatric surgery showed that mean estimated GFR increased in obese CKD patients.…”

Section: Treatment Of Obesity In Ckdmentioning

confidence: 99%

Obesity in CKD—What Should Nephrologists Know?

Stenvinkel

Zoccali

İkizler

2013

Journal of the American Society of Nephrology

200

172

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Obesity, the epidemic of the 21st century, carries a markedly increased risk for comorbid complications, such as type 2 diabetes, cancer, hypertension, dyslipidemia, cardiovascular disease, and sleep apnea. In addition, obesity increases the risk for CKD and its progression to ESRD. Paradoxically, even morbid obesity associates with better outcomes in studies of ESRD patients on maintenance dialysis. Because the number of obese CKD and maintenance dialysis patients is projected to increase markedly in developed as well as low-and middle-income countries, obesity is a rapidly emerging problem for the international renal community. Targeting the obesity epidemic represents an unprecedented opportunity for health officials to ameliorate the current worldwide increase in CKD prevalence. Nephrologists need more information about assessing and managing obesity in the setting of CKD. Specifically, more precise estimation of regional fat distribution and the amount of muscle mass should be introduced into regular clinical practice to complement more commonly used practical markers, such as body mass index. Studies examining the effects of obesity on kidney disease progression and other clinical outcomes along with weight management strategies are much needed in this orphan area of research. 24: 172724: -173624: , 201324: . doi: 10.1681 Obesity has emerged as the largest pandemic in near history, with important implications of not only cardiovascular disease (CVD) but also CKD. Recent data from the United States indicate that the incidence and prevalence rates of obesity in maintenance dialysis patients largely exceed the corresponding figures in the general population. 1 A large European population survey documented that a high body mass index (BMI) ranks as one of the strongest risk factors for new-onset CKD. 2 The dimension of the obesity epidemic and the impact of the same epidemic on the kidney demand efforts for understanding the epidemiology and the mechanisms of CKD associated with excess adiposity. It also sets as an absolute public health priority for the development of treatment policies integrated across specialties and general practice to halt this much concerning problem. In this scenario, it is fundamental that nephrologists are updated on current knowledge about obesity in the setting of CKD. However, little attention is still paid to this issue in major nephrology journals. The suboptimal attention to the problem by major sources of dissemination of specialty information suggests that nephrologists may have scarce knowledge of how obesity should be assessed, its epidemiology, mechanisms whereby excess fat mass is conducive to CKD, and management of obesity in the catabolic uremic milieu. 3 J Am Soc Nephrol DEFINITION AND ASSESSMENT OF OBESITYThe most common method for defining obesity is based on BMI (i.e., a person's weight as obese. It should be emphasized that population norms of BMI could be different based on ethnic and racial background (i.e., the proportion of Asian people with a high ...

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Section: Treatment Of Obesity In Ckdmentioning

confidence: 99%

Obesity in CKD—What Should Nephrologists Know?

Stenvinkel

Zoccali

İkizler

2013

Journal of the American Society of Nephrology

200

172

View full text Add to dashboard Cite

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“…Baseline kidney disease included glomerular hyperfiltration [13][14][15]19], overt CKD [16][17][18][19][20][21][22][23][24], or end-stage renal disease [16]. There are two studies [16,20] including patients on hemodialysis (HD) treatment.…”

Section: Studies On Bariatric Surgery Included Collectively 773mentioning

confidence: 99%

“…Both prospective studies by Alexander et al [16,17] reported a case series of patients who had resolution, improvement, or stabilization of their kidney function derived from obese study population after surgery. The type of surgery performed in these studies is heterogeneous.…”

Section: Studies On Bariatric Surgery Included Collectively 773mentioning

confidence: 99%

“…The type of surgery performed in these studies is heterogeneous. 4 studies considered Roux-en-Y gastric bypass [15][16][17]23], and 2 studies [20,24] performed sleeve gastrectomy, in which MacLaughlin et al [20] used laparoscopic sleeve gastrectomy, to achieve weight loss. In the study by Hou et al [19], of 233 total patients, 184 patients underwent gastric bypass, 32 patients had sleeve gastrectomy and gastric banding was performed for 14 remaining patients.…”

Section: Studies On Bariatric Surgery Included Collectively 773mentioning

confidence: 99%

“…Several studies support the fact that bariatric surgery on morbidly obese patients improve or stabilize their renal function and improve microalbuminuria [13][14][15][16][17][18]. However, surgical intervention has not yet been strongly recommended for the obese patients with CKD.…”

Section: Introductionmentioning

confidence: 99%

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Can Bariatric Surgery Be a Surgical Treatment to Prevent the Progression of Chronic Kidney Disease?

Choi

2016

J Metab Bariatr Surg

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Obesity is a serious worldwide health problem causing numerous obesity-related comorbidities such as hyperlipidemia, hypertension, diabetes, and cardiovascular dysfunctions. Recently, many studies indicate that obesity is strongly related with high rate of renal lesions and reducing weight with surgical intervention can improve renal parameters in obese patients, but the effect of bariatric surgery on obesity-induced chronic kidney disease (CKD) is hardly documented. This review study shows that bariatric surgery demonstrates beneficial reduction in proteinuria and albuminuria leading to improve both glomerular hyperfiltration and chronic kidney disease in obese population. Yet, bariatric surgery is not a definite treatment of choice for the obese patients with CKD because of lack of evidence explaining the risk of complications following bariatric surgery and clarification on estimating glomerular filtration rate (eGFR) in obese patients. Future, high quality studies with a long term follow up are required to determine the effective durability of bariatric surgery on obese-related CKD patients.

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Effect of Gastric Bypass vs Best Medical Treatment on Early-Stage Chronic Kidney Disease in Patients With Type 2 Diabetes and Obesity

et al. 2020

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IMPORTANCE Early-stage chronic kidney disease (CKD) characterized by microalbuminuria is associated with future cardiovascular events, progression toward end-stage renal disease, and early mortality in patients with type 2 diabetes.OBJECTIVE To compare the albuminuria-lowering effects of Roux-en-Y gastric bypass (RYGB) surgery vs best medical treatment in patients with early-stage CKD, type 2 diabetes, and obesity.DESIGN, SETTING, AND PARTICIPANTS For this randomized clinical trial, patients with established type 2 diabetes and microalbuminuria were recruited from a single center from April 1, 2013, through March 31, 2016, with a 5-year follow-up, including prespecified intermediate analysis at 24-month follow-up.INTERVENTION A total of 100 patients with type 2 diabetes, obesity (body mass indexes of 30 to 35 [calculated as weight in kilograms divided by height in meters squared]), and stage G1 to G3 and A2 to A3 CKD (urinary albumin-creatinine ratio [uACR] >30 mg/g and estimated glomerular filtration rate >30 mL/min) were randomized 1:1 to receive best medical treatment (n = 49) or RYGB (n = 51). MAIN OUTCOMES AND MEASURESThe primary outcome was remission of albuminuria (uACR <30 mg/g). Secondary outcomes were CKD remission rate, absolute change in uACR, metabolic control, other microvascular complications, quality of life, and safety.RESULTS A total of 100 patients (mean [SD] age, 51.4 [7.6] years; 55 [55%] male) were randomized: 51 to RYGB and 49 to best medical care. Remission of albuminuria occurred in 55% of patients (95% CI, 39%-70%) after best medical treatment and 82% of patients (95% CI, 72%-93%) after RYGB (P = .006), resulting in CKD remission rates of 48% (95% CI, 32%-64%) after best medical treatment and 82% (95% CI, 72%-92%) after RYGB (P = .002). The geometric mean uACRs were 55% lower after RYGB (10.7 mg/g of creatinine) than after best medical treatment (23.6 mg/g of creatinine) (P < .001). No difference in the rate of serious adverse events was observed. CONCLUSIONS AND RELEVANCEAfter 24 months, RYGB was more effective than best medical treatment for achieving remission of albuminuria and stage G1 to G3 and A2 to A3 CKD in patients with type 2 diabetes and obesity.

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Improvement and stabilization of chronic kidney disease after gastric bypass

Cited by 84 publications

References 20 publications

Obesity in CKD—What Should Nephrologists Know?

Obesity in CKD—What Should Nephrologists Know?

Can Bariatric Surgery Be a Surgical Treatment to Prevent the Progression of Chronic Kidney Disease?

Effect of Gastric Bypass vs Best Medical Treatment on Early-Stage Chronic Kidney Disease in Patients With Type 2 Diabetes and Obesity

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