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Published in: Obesity Surgery 8/2019

01-08-2019 | Obesity | Original Contributions

Impact of Preoperative Anemia on Postoperative Kidney Function Following Laparoscopic Bariatric Surgery

Authors: Kuo-Chuan Hung, Shao-Chun Wu, Ying-Jen Chang, Min-Hsien Chiang, I-Wen Chen, Cheuk-Kwan Sun, Tien-Chou Soong

Published in: Obesity Surgery | Issue 8/2019

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Abstract

Background

Preoperative anemia is a risk factor for acute kidney failure after high-risk surgeries. We assessed the impact of preoperative anemia on kidney function in an obese Asian population after laparoscopic bariatric surgery.

Methods

Patient characteristics, comorbidities, type of surgery, perioperative profiles, eGFR, and micronutrition were retrospectively reviewed in 341 patients with obesity undergoing bariatric surgery. All patients, who had a preoperative estimated glomerular filtration rates (eGFR) ≥ 90 mL/min/1.73 m2, were followed for 1 year and assigned to one of two groups: anemia or non-anemia group. Preoperative anemia was determined based on hemoglobin concentration.

Results

The Pearson’s correlation coefficient between preoperative body mass index (BMI) and preoperative eGFR of all patients was 0.169 (p = 0.005). Preoperatively, there were no significant differences in age, BMI, and eGFR between the anemia (n = 38) and non-anemia groups (n = 303). Patients in the anemia group had lower hemoglobin concentration at baseline, 1 month, and 12 months after surgery than those in the non-anemia group. Postoperative eGFR levels at 1 month (p = 0.993) and 1 year (p = 0.118) as well as hospital stay (p = 0.941) were comparable between the two groups. However, the percentage weight loss was significantly higher in the non-anemia group than that in the anemia group 1 year after bariatric surgery (30.0 ± 7.3% vs. 27.0 ± 8.1%; p = 0.041).

Conclusions

Preoperative anemia did not negatively impact kidney function following laparoscopic bariatric surgery during the 12-month follow-up. Considering the potential adverse impact of anemia on postoperative weight loss, preoperative correction of anemia may be recommended.
Literature
1.
go back to reference Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357:753–61.PubMedCrossRef Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357:753–61.PubMedCrossRef
2.
go back to reference Wang Y, Chen X, Song Y, et al. Association between obesity and kidney disease: a systematic review and meta-analysis. Kidney Int. 2008;73:19–33.PubMedCrossRef Wang Y, Chen X, Song Y, et al. Association between obesity and kidney disease: a systematic review and meta-analysis. Kidney Int. 2008;73:19–33.PubMedCrossRef
3.
go back to reference Wahba IM, Mak RH. Obesity and obesity-initiated metabolic syndrome: mechanistic links to chronic kidney disease. Clin J Am Soc Nephrol. 2007;2:550–62.PubMedCrossRef Wahba IM, Mak RH. Obesity and obesity-initiated metabolic syndrome: mechanistic links to chronic kidney disease. Clin J Am Soc Nephrol. 2007;2:550–62.PubMedCrossRef
4.
go back to reference Kheterpal S, Tremper KK, Heung M, et al. Development and validation of an acute kidney injury risk index for patients undergoing general surgery: results from a national data set. Anesthesiology. 2009;110:505–15.PubMedCrossRef Kheterpal S, Tremper KK, Heung M, et al. Development and validation of an acute kidney injury risk index for patients undergoing general surgery: results from a national data set. Anesthesiology. 2009;110:505–15.PubMedCrossRef
5.
go back to reference Jafari SM, Huang R, Joshi A, et al. Renal impairment following total joint arthroplasty: who is at risk? J Arthroplast. 2010;25:49–53. e1-2CrossRef Jafari SM, Huang R, Joshi A, et al. Renal impairment following total joint arthroplasty: who is at risk? J Arthroplast. 2010;25:49–53. e1-2CrossRef
6.
go back to reference Weingarten TN, Gurrieri C, McCaffrey JM, et al. Acute kidney injury following bariatric surgery. Obes Surg. 2013;23:64–70.PubMedCrossRef Weingarten TN, Gurrieri C, McCaffrey JM, et al. Acute kidney injury following bariatric surgery. Obes Surg. 2013;23:64–70.PubMedCrossRef
7.
go back to reference Weingarten TN, Swain JM, Kendrick ML, et al. Nonalcoholic steatohepatitis (NASH) does not increase complications after laparoscopic bariatric surgery. Obes Surg. 2011;21:1714–20.PubMedCrossRef Weingarten TN, Swain JM, Kendrick ML, et al. Nonalcoholic steatohepatitis (NASH) does not increase complications after laparoscopic bariatric surgery. Obes Surg. 2011;21:1714–20.PubMedCrossRef
8.
go back to reference Weingarten TN, Flores AS, McKenzie JA, et al. Obstructive sleep apnoea and perioperative complications in bariatric patients. Br J Anaesth. 2011;106:131–9.PubMedCrossRef Weingarten TN, Flores AS, McKenzie JA, et al. Obstructive sleep apnoea and perioperative complications in bariatric patients. Br J Anaesth. 2011;106:131–9.PubMedCrossRef
9.
go back to reference Thakar CV, Kharat V, Blanck S, et al. Acute kidney injury after gastric bypass surgery. Clin J Am Soc Nephrol. 2007;2:426–30.PubMedCrossRef Thakar CV, Kharat V, Blanck S, et al. Acute kidney injury after gastric bypass surgery. Clin J Am Soc Nephrol. 2007;2:426–30.PubMedCrossRef
10.
go back to reference Nor Hanipah Z, Punchai S, Augustin T, et al. Impact of early postbariatric surgery acute kidney injury on long-term renal function. Obes Surg. 2018;28:3580–5.PubMedCrossRef Nor Hanipah Z, Punchai S, Augustin T, et al. Impact of early postbariatric surgery acute kidney injury on long-term renal function. Obes Surg. 2018;28:3580–5.PubMedCrossRef
11.
go back to reference Wu W-C, Schifftner TL, Henderson WG, et al. Preoperative hematocrit levels and postoperative outcomes in older patients undergoing noncardiac surgery. Jama. 2007;297:2481–8.PubMedCrossRef Wu W-C, Schifftner TL, Henderson WG, et al. Preoperative hematocrit levels and postoperative outcomes in older patients undergoing noncardiac surgery. Jama. 2007;297:2481–8.PubMedCrossRef
12.
go back to reference Musallam KM, Tamim HM, Richards T, et al. Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet. 2011;378:1396–407.PubMedCrossRef Musallam KM, Tamim HM, Richards T, et al. Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet. 2011;378:1396–407.PubMedCrossRef
13.
go back to reference Baron DM, Hochrieser H, Posch M, et al. Preoperative anaemia is associated with poor clinical outcome in non-cardiac surgery patients. Br J Anaesth. 2014;113:416–23.PubMedCrossRef Baron DM, Hochrieser H, Posch M, et al. Preoperative anaemia is associated with poor clinical outcome in non-cardiac surgery patients. Br J Anaesth. 2014;113:416–23.PubMedCrossRef
14.
go back to reference Saager L, Turan A, Reynolds LF, et al. The association between preoperative anemia and 30-day mortality and morbidity in noncardiac surgical patients. Anesth Analg. 2013;117:909–15.PubMedCrossRef Saager L, Turan A, Reynolds LF, et al. The association between preoperative anemia and 30-day mortality and morbidity in noncardiac surgical patients. Anesth Analg. 2013;117:909–15.PubMedCrossRef
15.
go back to reference Beattie WS, Karkouti K, Wijeysundera DN, et al. Risk associated with preoperative anemia in noncardiac surgery: a single-center cohort study. Anesthesiology. 2009;110:574–81.PubMedCrossRef Beattie WS, Karkouti K, Wijeysundera DN, et al. Risk associated with preoperative anemia in noncardiac surgery: a single-center cohort study. Anesthesiology. 2009;110:574–81.PubMedCrossRef
16.
go back to reference Karkouti K, Grocott HP, Hall R, et al. Interrelationship of preoperative anemia, intraoperative anemia, and red blood cell transfusion as potentially modifiable risk factors for acute kidney injury in cardiac surgery: a historical multicentre cohort study. Can J Anaesth. 2015;62:377–84.PubMedCrossRef Karkouti K, Grocott HP, Hall R, et al. Interrelationship of preoperative anemia, intraoperative anemia, and red blood cell transfusion as potentially modifiable risk factors for acute kidney injury in cardiac surgery: a historical multicentre cohort study. Can J Anaesth. 2015;62:377–84.PubMedCrossRef
17.
go back to reference Kuriyam S, Tomonari H, Yoshida H, et al. Reversal of anemia by erythropoietin therapy retards the progression of chronic renal failure, especially in nondiabetic patients. Nephron. 1997;77:176–85.CrossRef Kuriyam S, Tomonari H, Yoshida H, et al. Reversal of anemia by erythropoietin therapy retards the progression of chronic renal failure, especially in nondiabetic patients. Nephron. 1997;77:176–85.CrossRef
18.
go back to reference Jungers P, Choukroun G, Oualim Z, et al. Beneficial influence of recombinant human erythropoietin therapy on the rate of progression of chronic renal failure in predialysis patients. Nephrol Dial Transplant. 2001;16:307–12.PubMedCrossRef Jungers P, Choukroun G, Oualim Z, et al. Beneficial influence of recombinant human erythropoietin therapy on the rate of progression of chronic renal failure in predialysis patients. Nephrol Dial Transplant. 2001;16:307–12.PubMedCrossRef
19.
go back to reference Lakdawala M, Bhasker A. Report: Asian Consensus Meeting on Metabolic Surgery. Recommendations for the use of bariatric and gastrointestinal metabolic surgery for treatment of obesity and type II diabetes mellitus in the Asian population: August 9th and 10th, 2008, Trivandrum, India. Obes Surg. 2010;20:929–36.PubMedCrossRef Lakdawala M, Bhasker A. Report: Asian Consensus Meeting on Metabolic Surgery. Recommendations for the use of bariatric and gastrointestinal metabolic surgery for treatment of obesity and type II diabetes mellitus in the Asian population: August 9th and 10th, 2008, Trivandrum, India. Obes Surg. 2010;20:929–36.PubMedCrossRef
20.
go back to reference Karkouti K, Wijeysundera DN, Yau TM, et al. Influence of erythrocyte transfusion on the risk of acute kidney injury after cardiac surgery differs in anemic and nonanemic patients. Anesthesiology. 2011;115:523–30.PubMedCrossRef Karkouti K, Wijeysundera DN, Yau TM, et al. Influence of erythrocyte transfusion on the risk of acute kidney injury after cardiac surgery differs in anemic and nonanemic patients. Anesthesiology. 2011;115:523–30.PubMedCrossRef
22.
go back to reference Magalhaes DSC, Pedro JMP, Souteiro PEB, et al. Analyzing the impact of bariatric surgery in kidney function: a 2-year observational study. Obes Surg. 2018; Magalhaes DSC, Pedro JMP, Souteiro PEB, et al. Analyzing the impact of bariatric surgery in kidney function: a 2-year observational study. Obes Surg. 2018;
23.
go back to reference Ngoh CLY, So JBY, Tiong HY, et al. Effect of weight loss after bariatric surgery on kidney function in a multiethnic Asian population. Surg Obes Relat Dis. 2016;12:600–5.PubMedCrossRef Ngoh CLY, So JBY, Tiong HY, et al. Effect of weight loss after bariatric surgery on kidney function in a multiethnic Asian population. Surg Obes Relat Dis. 2016;12:600–5.PubMedCrossRef
24.
go back to reference Weng TC, Chang CH, Dong YH, et al. Anaemia and related nutrient deficiencies after Roux-en-Y gastric bypass surgery: a systematic review and meta-analysis. BMJ Open. 2015;5:e006964.PubMedPubMedCentralCrossRef Weng TC, Chang CH, Dong YH, et al. Anaemia and related nutrient deficiencies after Roux-en-Y gastric bypass surgery: a systematic review and meta-analysis. BMJ Open. 2015;5:e006964.PubMedPubMedCentralCrossRef
26.
go back to reference Hall JE, Crook ED, Jones DW, et al. Mechanisms of obesity-associated cardiovascular and renal disease. Am J Med Sci. 2002;324:127–37.PubMedCrossRef Hall JE, Crook ED, Jones DW, et al. Mechanisms of obesity-associated cardiovascular and renal disease. Am J Med Sci. 2002;324:127–37.PubMedCrossRef
27.
go back to reference Coupaye M, Flamant M, Sami O, et al. Determinants of evolution of glomerular filtration rate after bariatric surgery: a 1-year observational study. Obes Surg. 2017;27:126–33.PubMedCrossRef Coupaye M, Flamant M, Sami O, et al. Determinants of evolution of glomerular filtration rate after bariatric surgery: a 1-year observational study. Obes Surg. 2017;27:126–33.PubMedCrossRef
30.
go back to reference Kambham N, Markowitz GS, Valeri AM, et al. Obesity-related glomerulopathy: an emerging epidemic. Kidney Int. 2001;59:1498–509.PubMedCrossRef Kambham N, Markowitz GS, Valeri AM, et al. Obesity-related glomerulopathy: an emerging epidemic. Kidney Int. 2001;59:1498–509.PubMedCrossRef
31.
go back to reference Praga M, Hernandez E, Morales E, et al. Clinical features and long-term outcome of obesity-associated focal segmental glomerulosclerosis. Nephrol Dial Transplant. 2001;16:1790–8.PubMedCrossRef Praga M, Hernandez E, Morales E, et al. Clinical features and long-term outcome of obesity-associated focal segmental glomerulosclerosis. Nephrol Dial Transplant. 2001;16:1790–8.PubMedCrossRef
32.
go back to reference Hou C-C, Shyu R-S, Lee W-J, et al. Improved renal function 12 months after bariatric surgery. Surg Obes Relat Dis. 2013;9:202–6.PubMedCrossRef Hou C-C, Shyu R-S, Lee W-J, et al. Improved renal function 12 months after bariatric surgery. Surg Obes Relat Dis. 2013;9:202–6.PubMedCrossRef
33.
go back to reference Peralta CA, Katz R, DeBoer I, et al. Racial and ethnic differences in kidney function decline among persons without chronic kidney disease. J Am Soc Nephrol. 2011;22:1327–34.PubMedPubMedCentralCrossRef Peralta CA, Katz R, DeBoer I, et al. Racial and ethnic differences in kidney function decline among persons without chronic kidney disease. J Am Soc Nephrol. 2011;22:1327–34.PubMedPubMedCentralCrossRef
34.
go back to reference Fenske WK, Dubb S, Bueter M, et al. Effect of bariatric surgery-induced weight loss on renal and systemic inflammation and blood pressure: a 12-month prospective study. Surg Obes Relat Dis. 2013;9:559–68.PubMedCrossRef Fenske WK, Dubb S, Bueter M, et al. Effect of bariatric surgery-induced weight loss on renal and systemic inflammation and blood pressure: a 12-month prospective study. Surg Obes Relat Dis. 2013;9:559–68.PubMedCrossRef
35.
go back to reference Jose B, Ford S, Super P, et al. The effect of biliopancreatic diversion surgery on renal function--a retrospective study. Obes Surg. 2013;23:634–7.PubMedCrossRef Jose B, Ford S, Super P, et al. The effect of biliopancreatic diversion surgery on renal function--a retrospective study. Obes Surg. 2013;23:634–7.PubMedCrossRef
36.
go back to reference Neff KJ, Baud G, Raverdy V, et al. Renal function and remission of hypertension after bariatric surgery: a 5-year prospective cohort study. Obes Surg. 2017;27:613–9.PubMedCrossRef Neff KJ, Baud G, Raverdy V, et al. Renal function and remission of hypertension after bariatric surgery: a 5-year prospective cohort study. Obes Surg. 2017;27:613–9.PubMedCrossRef
37.
go back to reference Morales E, Valero MA, León M, et al. Beneficial effects of weight loss in overweight patients with chronic proteinuric nephropathies. Am J Kidney Dis. 2003;41:319–27.PubMedCrossRef Morales E, Valero MA, León M, et al. Beneficial effects of weight loss in overweight patients with chronic proteinuric nephropathies. Am J Kidney Dis. 2003;41:319–27.PubMedCrossRef
38.
go back to reference Friedman AN, Yu Z, Juliar BE, et al. Independent influence of dietary protein on markers of kidney function and disease in obesity. Kidney Int. 2010;78:693–7.PubMedCrossRef Friedman AN, Yu Z, Juliar BE, et al. Independent influence of dietary protein on markers of kidney function and disease in obesity. Kidney Int. 2010;78:693–7.PubMedCrossRef
39.
go back to reference Faria SL, Faria OP, Buffington C, et al. Dietary protein intake and bariatric surgery patients: a review. Obes Surg. 2011;21:1798–805.PubMedCrossRef Faria SL, Faria OP, Buffington C, et al. Dietary protein intake and bariatric surgery patients: a review. Obes Surg. 2011;21:1798–805.PubMedCrossRef
40.
go back to reference Calbet JA, Lundby C, Koskolou M, et al. Importance of hemoglobin concentration to exercise: acute manipulations. Respir Physiol Neurobiol. 2006;151:132–40.PubMedCrossRef Calbet JA, Lundby C, Koskolou M, et al. Importance of hemoglobin concentration to exercise: acute manipulations. Respir Physiol Neurobiol. 2006;151:132–40.PubMedCrossRef
42.
go back to reference von Scholten BJ, Persson F, Svane MS, et al. Effect of large weight reductions on measured and estimated kidney function. BMC Nephrol. 2017;18:52.CrossRef von Scholten BJ, Persson F, Svane MS, et al. Effect of large weight reductions on measured and estimated kidney function. BMC Nephrol. 2017;18:52.CrossRef
43.
go back to reference Esposito C, Plati A, Mazzullo T, et al. Renal function and functional reserve in healthy elderly individuals. J Nephrol. 2007;20:617–25.PubMed Esposito C, Plati A, Mazzullo T, et al. Renal function and functional reserve in healthy elderly individuals. J Nephrol. 2007;20:617–25.PubMed
Metadata
Title
Impact of Preoperative Anemia on Postoperative Kidney Function Following Laparoscopic Bariatric Surgery
Authors
Kuo-Chuan Hung
Shao-Chun Wu
Ying-Jen Chang
Min-Hsien Chiang
I-Wen Chen
Cheuk-Kwan Sun
Tien-Chou Soong
Publication date
01-08-2019
Publisher
Springer US
Published in
Obesity Surgery / Issue 8/2019
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-019-03869-6

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