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Longitudinal assessment of renal function in native kidney after bariatric surgery.
Surg Obes Relat Dis. 2018 Sep; 14(9):1411-1418.SO

Abstract

The epidemic of obesity parallels that of chronic kidney disease (CKD). Obesity worsens the course of CKD, mainly defined by an abnormal glomerular filtration rate (GFR). Patients with severe obesity stages (II and III with body mass index >35 kg/m2) are eligible for bariatric surgery (BS), which is the most efficient method of achieving durable weight loss. BS may reverse glomerular hyperfiltration and albuminuria, improve adipocytokine profile, and relieve diabetes and hypertension. Obesity remission after BS might prevent the progression of renal failure in populations with morbid obesity. However, evidence for the beneficial effect of BS on renal function is scant. This lack of knowledge is mainly due to methodologic reasons, which are addressed in this review. The reversibility of hyperfiltration due to the presence of functional renal reserve hampers the interpretation of changes in true GFR after BS. This true GFR is only obtained with the renal clearance of an exogenous filtration marker. Estimation of GFR is generally provided by prediction equations, namely by modification of diet in renal diseases or by chronic kidney disease-epidemiology collaborative group. These equations are not accurate because the serum levels of both creatinine and cystatin C depend on extrarenal factors, which are modified by BS. Comparing the slopes of measured GFR according to various durations of exposure with morbid obesity would be critical in providing reliable data. Herein, we review the current knowledge on the effects of BS on kidney function; we specify the methodologic issues and particularities of the dietary management of CKD patients to propose reliable directions for future clinical research.

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Authors+Show Affiliations

Favre G
Service de Néphrologie-Dialyses-Transplantation, Hôpital Pasteur, Nice; CNRS-UMR 7370 - Laboratoire de Physiomedecine moléculaire, Nice; Université Côte d'Azur, Faculté de Médecine, Nice. Electronic address: favre.g@chu-nice.fr.
Schiavo L
Department of Cardio-Thoracic and Respiratory Science, University of Campania Luigi Vanvitelli, Naples, Italy; IX Division of General Surgery, Vascular Surgery, and Applied Biotechnology, Naples University Polyclinic, Naples, Italy.
Lemoine S
Service de néphrologie et d'exploration fonctionnelle rénale, Lyon, France; Université de Lyon, Université Lyon 1, Villeurbanne, France; Centre de référence des maladies rénales rares, Bron, France.
Esnault VLM
Service de Néphrologie-Dialyses-Transplantation, Hôpital Pasteur, Nice; Université Côte d'Azur, Faculté de Médecine, Nice.
Iannelli A
Université Côte d'Azur, Faculté de Médecine, Nice; Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, University Hospital of Nice, Nice, France; INSERM, U1065, Team 8 "Hepatic complications of obesity", Nice, France.

MeSH

Bariatric SurgeryGlomerular Filtration RateHumansKidneyObesity, MorbidRenal Insufficiency, Chronic

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

30077663

Citation

Favre, Guillaume, et al. "Longitudinal Assessment of Renal Function in Native Kidney After Bariatric Surgery." Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, vol. 14, no. 9, 2018, pp. 1411-1418.
Favre G, Schiavo L, Lemoine S, et al. Longitudinal assessment of renal function in native kidney after bariatric surgery. Surg Obes Relat Dis. 2018;14(9):1411-1418.
Favre, G., Schiavo, L., Lemoine, S., Esnault, V. L. M., & Iannelli, A. (2018). Longitudinal assessment of renal function in native kidney after bariatric surgery. Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, 14(9), 1411-1418. https://doi.org/10.1016/j.soard.2018.05.013
Favre G, et al. Longitudinal Assessment of Renal Function in Native Kidney After Bariatric Surgery. Surg Obes Relat Dis. 2018;14(9):1411-1418. PubMed PMID: 30077663.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Longitudinal assessment of renal function in native kidney after bariatric surgery. AU - Favre,Guillaume, AU - Schiavo,Luigi, AU - Lemoine,Sandrine, AU - Esnault,Vincent L M, AU - Iannelli,Antonio, Y1 - 2018/05/24/ PY - 2018/01/31/received PY - 2018/04/09/revised PY - 2018/05/16/accepted PY - 2018/8/6/pubmed PY - 2019/2/23/medline PY - 2018/8/6/entrez KW - Bariatric surgery KW - Chronic kidney disease KW - Functional renal reserve KW - Glomerular filtration rate KW - Hyperfiltration KW - Morbid obesity SP - 1411 EP - 1418 JF - Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery JO - Surg Obes Relat Dis VL - 14 IS - 9 N2 - The epidemic of obesity parallels that of chronic kidney disease (CKD). Obesity worsens the course of CKD, mainly defined by an abnormal glomerular filtration rate (GFR). Patients with severe obesity stages (II and III with body mass index >35 kg/m2) are eligible for bariatric surgery (BS), which is the most efficient method of achieving durable weight loss. BS may reverse glomerular hyperfiltration and albuminuria, improve adipocytokine profile, and relieve diabetes and hypertension. Obesity remission after BS might prevent the progression of renal failure in populations with morbid obesity. However, evidence for the beneficial effect of BS on renal function is scant. This lack of knowledge is mainly due to methodologic reasons, which are addressed in this review. The reversibility of hyperfiltration due to the presence of functional renal reserve hampers the interpretation of changes in true GFR after BS. This true GFR is only obtained with the renal clearance of an exogenous filtration marker. Estimation of GFR is generally provided by prediction equations, namely by modification of diet in renal diseases or by chronic kidney disease-epidemiology collaborative group. These equations are not accurate because the serum levels of both creatinine and cystatin C depend on extrarenal factors, which are modified by BS. Comparing the slopes of measured GFR according to various durations of exposure with morbid obesity would be critical in providing reliable data. Herein, we review the current knowledge on the effects of BS on kidney function; we specify the methodologic issues and particularities of the dietary management of CKD patients to propose reliable directions for future clinical research. SN - 1878-7533 UR - https://www.unboundmedicine.com/medline/citation/30077663/Longitudinal_assessment_of_renal_function_in_native_kidney_after_bariatric_surgery_ DB - PRIME DP - Unbound Medicine ER -