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Effect of weight loss on the estimated glomerular filtration rates of obese patients at risk of chronic kidney disease: the RIGOR-TMU study.
J Cachexia Sarcopenia Muscle. 2019 Aug; 10(4):756-766.JC

Abstract

BACKGROUND

Weight-reduction therapies, including bariatric surgery (BS), are standard treatments for severely obese patients with type 2 diabetes; however, the outcomes of these therapies are inconclusive for obese patients with chronic kidney disease (CKD). This study aimed to investigate the effects of BS or non-surgical interventions on the estimated glomerular filtration rate (eGFR) and to determine whether BS can be recommended for renal function preservation based on body mass index (BMI) and eGFR changes in obese patients with CKD.

METHODS

This study used data from the weight Reduction Intervention on GFR in Obese Patients with Renal Impairment-Taipei Medical University (TMU) study, which was a large, long-term, propensity score-matched cohort study based on clinical data from patients who registered at weight-reduction centres at TMU and its affiliated hospitals from 2008 to 2016. The patients were stratified according to whether they had undergone BS and into the mild, moderate, and high CKD risk groups using the Kidney Disease: Improving Global Outcomes guidelines. The primary outcome was the eGFR calculated using the Taiwan Chronic Kidney Disease-Epidemiology Collaboration equation. Cox regression models were used to determine hazard ratios (HRs) for eGFR decreases ≥25%.

RESULTS

A total of 4332 obese patients were enrolled in this study. After propensity score matching, 1620 patients, including 60.2% women, with a mean age of 36.5 (9.9) years were divided into BS or non-surgery groups (n = 810 per group). The overall mean eGFRs increased by 4.4 (14) mL/min·1.73 m2 and decreased by 6.4 (16.0) mL/min·1.73 m2 in the BS and non-surgery groups, respectively. The decrease in BMI in the BS and non-surgery groups were 2.5 and 1.3 kg/m2 , respectively. In the moderate/high CKD risk BS group, a significant correlation was evident between an increased eGFR and a reduced BMI (Spearman's correlation -0.229, P < 0.001). The Cox regression analysis showed that the BS group had a significantly lower risk of an eGFR decline ≥25% at 12 months [adjusted HR (aHR) 0.47, P = 0.03). After BS, obese patients with hypertension or albuminuria had significantly lower risks of eGFR declines ≥25% (aHR 0.37, P = 0.02 and aHR 0.13, P = 0.0018, respectively).

CONCLUSIONS

Bariatric surgery was associated with eGFR preservation in all obese patients and, particularly, in those with moderate-to-high CKD risks. A longer term outcome study is warranted to determine the benefits of BS for CKD patients.

Authors+Show Affiliations

Graduate Institute of Clinical Medicine, School of Medicine, College of Medine, Taipei Medical University, Taipei, Taiwan. Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan. Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan.Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan. Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.Graduate Institute of Clinical Medicine, School of Medicine, College of Medine, Taipei Medical University, Taipei, Taiwan.Graduate Institute of Clinical Medicine, School of Medicine, College of Medine, Taipei Medical University, Taipei, Taiwan. Division of Urology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan. Office of Information Technology, Taipei Medical University, Taipei, Taiwan.Graduate Institute of Clinical Medicine, School of Medicine, College of Medine, Taipei Medical University, Taipei, Taiwan. Division of Nephrology, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan. Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei, Taiwan.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30938491

Citation

Lin, Yen-Chung, et al. "Effect of Weight Loss On the Estimated Glomerular Filtration Rates of Obese Patients at Risk of Chronic Kidney Disease: the RIGOR-TMU Study." Journal of Cachexia, Sarcopenia and Muscle, vol. 10, no. 4, 2019, pp. 756-766.
Lin YC, Lai YJ, Lin YC, et al. Effect of weight loss on the estimated glomerular filtration rates of obese patients at risk of chronic kidney disease: the RIGOR-TMU study. J Cachexia Sarcopenia Muscle. 2019;10(4):756-766.
Lin, Y. C., Lai, Y. J., Lin, Y. C., Peng, C. C., Chen, K. C., Chuang, M. T., Wu, M. S., & Chang, T. H. (2019). Effect of weight loss on the estimated glomerular filtration rates of obese patients at risk of chronic kidney disease: the RIGOR-TMU study. Journal of Cachexia, Sarcopenia and Muscle, 10(4), 756-766. https://doi.org/10.1002/jcsm.12423
Lin YC, et al. Effect of Weight Loss On the Estimated Glomerular Filtration Rates of Obese Patients at Risk of Chronic Kidney Disease: the RIGOR-TMU Study. J Cachexia Sarcopenia Muscle. 2019;10(4):756-766. PubMed PMID: 30938491.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of weight loss on the estimated glomerular filtration rates of obese patients at risk of chronic kidney disease: the RIGOR-TMU study. AU - Lin,Yen-Chung, AU - Lai,Yi-Jen, AU - Lin,Yi-Chun, AU - Peng,Chiung-Chi, AU - Chen,Kuan-Chou, AU - Chuang,Ming-Tsang, AU - Wu,Mai-Szu, AU - Chang,Tzu-Hao, Y1 - 2019/04/02/ PY - 2018/9/7/received PY - 2019/2/19/accepted PY - 2019/4/3/pubmed PY - 2020/7/21/medline PY - 2019/4/3/entrez KW - Albuminuria KW - Bariatric surgery KW - Chronic kidney disease KW - Estimated glomerular filtration rate KW - Obesity SP - 756 EP - 766 JF - Journal of cachexia, sarcopenia and muscle JO - J Cachexia Sarcopenia Muscle VL - 10 IS - 4 N2 - BACKGROUND: Weight-reduction therapies, including bariatric surgery (BS), are standard treatments for severely obese patients with type 2 diabetes; however, the outcomes of these therapies are inconclusive for obese patients with chronic kidney disease (CKD). This study aimed to investigate the effects of BS or non-surgical interventions on the estimated glomerular filtration rate (eGFR) and to determine whether BS can be recommended for renal function preservation based on body mass index (BMI) and eGFR changes in obese patients with CKD. METHODS: This study used data from the weight Reduction Intervention on GFR in Obese Patients with Renal Impairment-Taipei Medical University (TMU) study, which was a large, long-term, propensity score-matched cohort study based on clinical data from patients who registered at weight-reduction centres at TMU and its affiliated hospitals from 2008 to 2016. The patients were stratified according to whether they had undergone BS and into the mild, moderate, and high CKD risk groups using the Kidney Disease: Improving Global Outcomes guidelines. The primary outcome was the eGFR calculated using the Taiwan Chronic Kidney Disease-Epidemiology Collaboration equation. Cox regression models were used to determine hazard ratios (HRs) for eGFR decreases ≥25%. RESULTS: A total of 4332 obese patients were enrolled in this study. After propensity score matching, 1620 patients, including 60.2% women, with a mean age of 36.5 (9.9) years were divided into BS or non-surgery groups (n = 810 per group). The overall mean eGFRs increased by 4.4 (14) mL/min·1.73 m2 and decreased by 6.4 (16.0) mL/min·1.73 m2 in the BS and non-surgery groups, respectively. The decrease in BMI in the BS and non-surgery groups were 2.5 and 1.3 kg/m2 , respectively. In the moderate/high CKD risk BS group, a significant correlation was evident between an increased eGFR and a reduced BMI (Spearman's correlation -0.229, P < 0.001). The Cox regression analysis showed that the BS group had a significantly lower risk of an eGFR decline ≥25% at 12 months [adjusted HR (aHR) 0.47, P = 0.03). After BS, obese patients with hypertension or albuminuria had significantly lower risks of eGFR declines ≥25% (aHR 0.37, P = 0.02 and aHR 0.13, P = 0.0018, respectively). CONCLUSIONS: Bariatric surgery was associated with eGFR preservation in all obese patients and, particularly, in those with moderate-to-high CKD risks. A longer term outcome study is warranted to determine the benefits of BS for CKD patients. SN - 2190-6009 UR - https://www.unboundmedicine.com/medline/citation/30938491/Effect_of_weight_loss_on_the_estimated_glomerular_filtration_rates_of_obese_patients_at_risk_of_chronic_kidney_disease:_the_RIGOR_TMU_study_ DB - PRIME DP - Unbound Medicine ER -