Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ASCO Annual Meeting 2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

2024 ASCO Annual Meeting

Keep up to date with all the top stories and latest evidence with our hub page, including official congress videos and expert takeaways.
ADVANCED SEARCH
Log in
Top
International Urology and Nephrology
Published in: International Urology and Nephrology 1/2013

01-02-2013 | Nephrology – Original Paper

GFR estimation in the morbidly obese pre- and postbariatric surgery: one size does not fit all

Authors: Samra Abouchacra, Ahmed Chaaban, Nicole Gebran, Qutaiba Hussein, Mohamad Ahmed, Bassam Bernieh, Fowaz Torab, Yasser Kayyal, Hanan Al Omary, Nico Nagelkerke

Published in: International Urology and Nephrology | Issue 1/2013

Login to get access

Abstract

Background

Glomerular hyperfiltration commonly associated with obesity is expected to improve postbariatric surgery. However, formula-based glomerular filtration rate (GFR) estimation in these patients is limited by body size confounders necessitating use of modified equations, the reliability of which remains uncertain.

Methods

In this study, various GFR-estimating formulae were compared in morbidly obese patients at baseline and postbariatric surgery. Through a retrospective chart review, we identified 220 patients who had undergone this procedure, with over 6-month follow-up, during which major weight reduction was achieved.

Results

A significant decrease in BP and glomerular hyperfiltration was observed, though there was large variability in GFR estimation using the different formulae. Gross over and underestimation was observed which improved with correction for body size confounders especially lean body weight (LBW). Postoperatively, significant attenuation in estimated GFR was demonstrated when LBW or body surface area-adjusted versions were used. In a subgroup of patients with chronic kidney disease, a significant improvement in GFR was seen postoperatively with the LBW-modified formula but there were again inconsistencies when using other equations.

Conclusion

Though clinicians must be critical in the application of GFR estimates to patient care, LBW adjustment appears to be the most practical solution to its estimation in the obese patients. This is particularly true for patients with normal renal function but appears to be also applicable to those with compromised kidney function. Future studies are needed to compare these equations with a gold standard GFR measure as well as to explore whether the renal benefits from bariatric surgery are sustained or seen in more advanced CKD stages.
Literature
1.
Wuerzner G, Pruijm M, Maillard M et al (2010) Marked association between obesity and glomerular hyperfiltration: a cross-sectional study in an African population. No association between BMI categories and GFR was found with adjustment for body surface area. Am J Kidney Dis 56(2):303–312PubMedCrossRef
2.
Levey AS, Kramer H (2010) Obesity, glomerular hyperfiltration, and the surface area correction. Am J Kidney Dis 56(2):255–258PubMedCrossRef
3.
Henegar JR, Bigler SA, Henegar LK, Tyagi SC, Hall JE (2001) Functional and structural changes in the kidney in the early stages of obesity. J Am Soc Nephrol 12(6):1211–1217PubMed
4.
Chagnac A, Weinstein T, Korzets A, Ramadan E, Hirsch J, Gafter U (2000) Glomerular hemodynamics in severe obesity. Am J Physiol 278:F817–F822
5.
Henegar JR, Bigler SA, Henegar LK, Tyagi SC, Hall JE (2001) Functional and structural changes in the kidney in the early stages of obesity. J Am Soc Nephro 12:1211–1217
6.
Toto RD, Greene T, Hebert LA, et al, AASK Collaborative Research Group (2010) Relationship between body mass index and proteinuria in hypertensive nephrosclerosis: results from the African American Study of Kidney Disease and Hypertension (AASK) cohor. Am J Kidney Dis 56(5):896–906
7.
Chen J, Munter P, Hamm LL et al (2004) The metabolic syndrome and chronic kidney disease in US adults. Ann Intern Med 140:167–174PubMed
8.
Kambham N, Markowitz GS, Valeri AM, Lin J, D’Agati VD (2001) Obesity-related glomerulopathy: an emerging epidemic. Kidney Int 59:1498–1509PubMedCrossRef
9.
Praga M, Hernandez E, Morales E et al (2001) Clinical features and long-term outcome of obesity-associated focal segmental glomerulosclerosis. Nephrol Dial Transplant 16:1790–1798PubMedCrossRef
10.
Adelman RD, Restaino IG, Alon US, Blowley DL (2001) Proteinuria and focal segmental glomerulosclerosis in severely obese adolescents. J Pediatr 138:481–485PubMedCrossRef
11.
Tuck ML, Sowers J, Dornfeld L, Kledzik G, Maxwell M (1981) The effect of weight reduction on blood pressure, plasma renin activity, and plasma aldosterone levels in obese patients. N Engl J Med 304:930–933PubMedCrossRef
12.
Engeli S, Bohnke J, Gorzelniak K et al (2005) Weight loss and the renin–angiotensin–aldosterone system. Hypertension 45:356–362PubMedCrossRef
13.
Dandona P, Aljada A, Chaudhuri A, Mohanty P, Garg R (2005) Metabolic syndrome: a comprehensive perspective based on interactions between obesity, diabetes, and inflammation. Circulation 111:1448–1454
14.
Wisse BE (2004) The inflammatory syndrome: the role of adipose tissue cytokines in metabolic disorders linked to obesity. J Am Soc Nephrol 5:2792–2800CrossRef
15.
National Kidney Foundation (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39:S1–266
16.
Verhave JC, Fesler P, Ribstein J, du Cailar G, Mimran A (2005) Estimation of renal function in subjects with normal serum creatinine levels: influence of age and body mass index. Am J Kidney Dis 46(2):233–241PubMedCrossRef
17.
Schold JD, Navaneethan SD, Jolly SE et al (2009) Implications of the CKD-EPI GFR estimation equation in clinical practice. J Nephrol 22(3):373–380
18.
Hudson JQ, Mason DL, Huch KM (2011) Estimates of kidney function in obese African Americans with chronic kidney disease. Nephron Clin Pract 118(2):c101–c108PubMedCrossRef
19.
Rigalleau V, Lasseur C, Perlemoine C et al (2006) Cockcroft-Gault formula is biased by body weight in diabetic patients with renal impairment. Metabolism 55(1):108–112PubMedCrossRef
20.
Nair S, Mishra V, Hayden K et al (2011) The four-variable modification of diet in renal disease formula underestimates glomerular filtration rate in obese type 2 diabetic individuals with chronic kidney disease. Diabetologia 54(6):1304–1307PubMedCrossRef
21.
Stevens LA, Coresh J, Feldman HI et al (2007) Evaluation of the modification of diet in renal disease study equation in large diverse population. J Am Soc Nephrol 18:2749–2757PubMedCrossRef
22.
Lim WH, Lim EM, McDonald S (2006) Lean body mass-adjusted Cockcroft and Gault formula improves the estimation of glomerular filtration rate in subjects with normal-range serum creatinine). Nephrology (Carlton) 11(3):250–256CrossRef
23.
Ozmen S, Kaplan MA, Kaya H et al (2009) Role of lean body mass for estimation of glomerular filtration rate in patients with chronic kidney disease with various body mass. Scand J Urol Nephrol 43(2):171–176PubMedCrossRef
24.
O’Brien PE, Dixon JB, Laurie C et al (2006) Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive medical program: a randomized trial. Ann Intern Med 144:625–633PubMed
25.
Giusti V, Suter M, Héraïef E, Gaillard RC, Burckhardt P (2004) Effects of laparoscopic gastric banding on body composition, metabolic profile and nutritional status of obese women: 12-months follow-up. Obes Surg 14(2):239–245PubMedCrossRef
26.
Karason K, Wikstrand J, Sjöström L, Wendelhag I (1999) Weight loss and progression of early atherosclerosis in the carotid artery: a four-year controlled study of obese subjects. Int J Obes Relat Metab Disord 23(9):948–956PubMedCrossRef
27.
Buchwald H, Avidor Y, Braunwald E et al (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292:1724–1737 Published erratum appears in JAMA 293:1728, 2005PubMedCrossRef
28.
Serpa Neto A, Bianco Rossi FM, Dal Moro Amarante R, Alves Buriti N, Cunha Barbosa Saheb G, Rossi M (2009) Effect of weight loss after Roux-en-Y gastric bypass, on renal function and blood pressure in morbidly obese patients. J Nephrol 22(5):637–646PubMed
29.
Matsushita K, Selvin E, Bash LD, Astor BC, Coresh J (2010) Risk Implications of the New CKD Epidemiology Collaboration (CKD-EPI) equation compared with the MDRD Study equation for estimated GFR: the Atherosclerosis Risk in Communities (ARIC) Study. Am J Kidney Dis 55(4):648–659PubMedCrossRef
30.
Green B, Duffull SB (2004) What is the best size descriptor to use for pharmacokinetic studies in the obese? Br J Clin Pharmacol 58(2):119–133
31.
Levey AS, Stevens LA (2010) Estimating GFR using the CKD epidemiology collaboration (CKD-EPI) creatinine equation: more accurate GFR estimates, lower CKD prevalence estimates, and better risk predictions. Am J Kidney Dis 55(4):622–627PubMedCrossRef
32.
Currie A, Chetwood A, Ahmed AR (2011) Bariatric surgery and renal function. Obes Surg 21(4):528–539PubMedCrossRef
33.
Navaneethan SD, Yehnert H, Moustarah F, Schreiber MJ, Schauer PR, Beddhu S (2009) Weight loss interventions in chronic kidney disease: a systematic review and meta-analysis. Clin J Am Soc Nephrol 4(10):1565–1574PubMedCrossRef
Metadata
Title
GFR estimation in the morbidly obese pre- and postbariatric surgery: one size does not fit all
Authors
Samra Abouchacra
Ahmed Chaaban
Nicole Gebran
Qutaiba Hussein
Mohamad Ahmed
Bassam Bernieh
Fowaz Torab
Yasser Kayyal
Hanan Al Omary
Nico Nagelkerke
Publication date
01-02-2013
Publisher
Springer Netherlands
Published in
International Urology and Nephrology / Issue 1/2013
Print ISSN: 0301-1623
Electronic ISSN: 1573-2584
DOI
https://doi.org/10.1007/s11255-012-0131-2

Other articles of this Issue 1/2013

International Urology and Nephrology 1/2013 Go to the issue

Nephrology – Original Paper

Relative contributions of inflammation and inadequate protein intake to hypoalbuminemia in patients on maintenance hemodialysis

Urology - Review

Does using comprehensive preoperative bowel preparation offer any advantage for urinary diversion using ileum? A meta-analysis

Nephrology - Original Paper

Influence of peritoneal dialysis solution on measurements of fluid status by bioimpedance spectroscopy

Nephrology – Original Paper

Serum osteocalcin levels are useful as a predictor of cardiovascular events in maintenance hemodialysis patients

Nephrology - Original Paper

Routine use of an abbreviated 4-item scale to assess dependence in essential activities of daily living amongst elderly hemodialysis patients: a validation study

Nephrology - Original Paper

The ureteroscope-assisted “Mini-Perc” technique of placement of peritoneal dialysis catheters with a 16-Fr Peel-Away sheath: 3-year results in 47 patients
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Image Credits