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Obesity Surgery
Published in: Obesity Surgery 10/2021

01-10-2021 | Obesity | Original Contributions

Improvement of Renal Function After Bariatric Surgery: a Systematic Review and Meta-analysis

Authors: Hongyan Huang, Jun Lu, Xiaojiang Dai, Zhixin Li, Liyong Zhu, Shaihong Zhu, Liangping Wu

Published in: Obesity Surgery | Issue 10/2021

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Abstract

Background/Objective

The effect of bariatric surgery in renal function varies and the postoperative benefit time point remains unclear. We aim to assess the changes of renal function after bariatric surgery (BS) in different postoperative periods and subgroups.

Methods

We searched the databases of PubMed and Cochrane from inception to December 14, 2020. Articles included in the study were drawn from all recipients of BS that provided assessments of renal function pre and post-surgery. Meta-analysis was performed to compare glomerular filtration rate (GFR), serum creatinine, albumin-to-creatinine ratio (ACR), and albuminuria before and after BS.

Results

The study included 49 articles involving 8515 patients. Compared with pre-operative renal function, the overall analysis showed that bariatric surgery significantly reduced serum creatinine levels, ACR, and albuminuria. There was significant increase of GFR in the CKD subgroup, yet a noticeable decrease in the hyperfiltration subgroup. The most significant improvement in GFR was seen 6–12 months after BS, while ACR dropped most dramatically 12–24 months after BS.

Conclusions

Bariatric surgery can improve renal function in obese patients with kidney dysfunction, especially 1 year after surgery.

Graphical abstract

Appendix
Available only for authorised users
Literature
1.
Yun HR, et al. Obesity, metabolic abnormality, and progression of CKD. Am J Kidney Dis. 2018;72(3):400–10.PubMedCrossRef
2.
3.
Xu T, Sheng Z, Yao L. Obesity-related glomerulopathy: pathogenesis, pathologic, clinical characteristics and treatment. Front Med. 2017;11(3):340–8.PubMedCrossRef
4.
5.
Climent E, et al. Atherogenic dyslipidemia remission 1 year after bariatric surgery. Obes Surg. 2017;27(6):1548–53.PubMedCrossRef
6.
7.
Holcomb CN, et al. Bariatric surgery is associated with renal function improvement. Surg Endosc. 2018;32(1):276–81.PubMedCrossRef
8.
Kim EY, Kim YJ. Does bariatric surgery really prevent deterioration of renal function? Surg Obes Relat Dis. 2016;12(4):856–61.PubMedCrossRef
9.
Saeed K, et al. Bariatric surgery improves renal function: a large inner-city population outcome study. Obes Surg. 2021;31(1):260–6.
10.
Carbone A, et al. Obesity and kidney stone disease: a systematic review. Minerva Urol Nefrol. 2018;70(4):393–400.PubMedCrossRef
11.
Monda S, et al. The risks of stone diagnosis and stone removal procedure after different bariatric surgeries. J Endourol. 2021;35(5):674–81.
12.
Zhou X, et al. Impact of bariatric surgery on renal functions in patients with type 2 diabetes: systematic review of randomized trials and observational studies. Surg Obes Relat Dis. 2016;12(10):1873–82.PubMedCrossRef
13.
Li K, et al. Effects of bariatric surgery on renal function in obese patients: a systematic review and meta analysis. PLoS One. 2016;11(10):e0163907.
14.
Upala S, et al. Bariatric surgery reduces urinary albumin excretion in diabetic nephropathy: a systematic review and meta-analysis. Surg Obes Relat Dis. 2016;12(5):1037–44.PubMedCrossRef
15.
Shulman A, et al. Remission and progression of pre-existing micro- and macroalbuminuria over 15 years after bariatric surgery in Swedish obese subjects study. Int J Obes (Lond). 2021;45(3):535–46.
16.
Bjornstad P, et al. Five-year kidney outcomes of bariatric surgery differ in severely obese adolescents and adults with and without type 2 diabetes. Kidney Int. 2020;97(5):995–1005.PubMedPubMedCentralCrossRef
17.
McIsaac M, et al. Long-term impact of bariatric surgery on renal outcomes at a community-based publicly funded bariatric program: the Regina bariatric study. Can J Kidney Health Dis. 2019;6:2054358119884903.PubMedPubMedCentralCrossRef
18.
Friedman AN, et al. The association between kidney disease and diabetes remission in bariatric surgery patients with type 2 diabetes. Am J Kidney Dis. 2019;74(6):761–70.PubMedPubMedCentralCrossRef
19.
Khalil R, et al. Kidney injury molecule-1: a potential marker of renal recovery after laparoscopic sleeve gastrectomy. Kidney Res Clin Pract. 2020;39(2):162–71.PubMedPubMedCentralCrossRef
20.
Brix JM, et al. Albuminuria in patients with morbid obesity and the effect of weight loss following bariatric surgery. Obes Surg. 2019;29(11):3581–8.PubMedCrossRef
21.
Young L, et al. Long-term impact of bariatric surgery in diabetic nephropathy. Surg Endosc. 2019;33(5):1654–60.PubMedCrossRef
22.
Park S, et al. Bariatric surgery can reduce albuminuria in patients with severe obesity and normal kidney function by reducing systemic inflammation. Obes Surg. 2018;28(3):831–7.PubMedCrossRef
23.
Billeter AT, et al. Renal function in type 2 diabetes following gastric bypass. Dtsch Arztebl Int. 2016;113(49):827–33.PubMed
24.
Nehus EJ, et al. Kidney outcomes three years after bariatric surgery in severely obese adolescents. Kidney Int. 2017;91(2):451–8.PubMedCrossRef
25.
Neff KJ, et al. Renal function and remission of hypertension after bariatric surgery: a 5-year prospective cohort study. Obes Surg. 2017;27(3):613–9.PubMedCrossRef
26.
Garcia MS, et al. Renal function 1 year after bariatric surgery: influence of Roux-en-Y gastric bypass and identification of pre-operative predictors of improvement. Obes Surg. 2020;30(3):860–6.PubMedCrossRef
27.
Solini A, et al. Renal resistive index predicts post-bariatric surgery renal outcome in nondiabetic individuals with severe obesity. Obesity (Silver Spring). 2019;27(1):68–74.CrossRef
28.
Hung KC, et al. Impact of serum uric acid on renal function after bariatric surgery: a retrospective study. Surg Obes Relat Dis. 2020;16(2):288–95.PubMedCrossRef
29.
Hou CC, et al. Improved renal function 12 months after bariatric surgery. Surg Obes Relat Dis. 2013;9(2):202–6.PubMedCrossRef
30.
Mirajkar N, et al. The impact of bariatric surgery on estimated glomerular filtration rate in patients with type 2 diabetes: a retrospective cohort study. Surg Obes Relat Dis. 2016;12(10):1883–9.PubMedCrossRef
31.
Reid TJ, et al. The effect of bariatric surgery on renal function. Surg Obes Relat Dis. 2014;10(5):808–13.PubMedCrossRef
32.
Fenske WK, 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(4):559–68.PubMedCrossRef
33.
Navaneethan SD, Yehnert H. Bariatric surgery and progression of chronic kidney disease. Surg Obes Relat Dis. 2009;5(6):662–5.PubMedCrossRef
34.
De Paula AL, et al. Prospective randomized controlled trial comparing 2 versions of laparoscopic ileal interposition associated with sleeve gastrectomy for patients with type 2 diabetes with BMI 21–34 kg/m(2). Surg Obes Relat Dis. 2010;6(3):296–304.PubMedCrossRef
35.
Zakaria AS, et al. Effects of gastric banding on glucose tolerance, cardiovascular and renal function, and diabetic complications: a 13-year study of the morbidly obese. Surg Obes Relat Dis. 2016;12(3):587–95.PubMedCrossRef
36.
Ngoh CLY, et al. Effect of weight loss after bariatric surgery on kidney function in a multiethnic Asian population. Surg Obes Relat Dis. 2016;12(3):600–5.PubMedCrossRef
37.
Miras AD, et al. Type 2 diabetes mellitus and microvascular complications 1 year after Roux-en-Y gastric bypass: a case-control study. Diabetologia. 2015;58(7):1443–7.PubMedPubMedCentralCrossRef
38.
Chagnac A, et al. The effects of weight loss on renal function in patients with severe obesity. J Am Soc Nephrol. 2003;14(6):1480–6.PubMedCrossRef
39.
Zhang H, et al. The short-term remission of diabetic nephropathy after Roux-en-Y gastric bypass in Chinese patients of T2DM with obesity. Obes Surg. 2015;25(7):1263–70.PubMedPubMedCentralCrossRef
40.
Stephenson DT, et al. Improvement in albuminuria in patients with type 2 diabetes after laparoscopic adjustable gastric banding. Diab Vasc Dis Res. 2013;10(6):514–9.PubMedCrossRef
41.
Abouchacra S, et al. GFR estimation in the morbidly obese pre- and postbariatric surgery: one size does not fit all. Int Urol Nephrol. 2013;45(1):157–62.PubMedCrossRef
42.
Amor A, et al. Weight loss independently predicts urinary albumin excretion normalization in morbidly obese type 2 diabetic patients undergoing bariatric surgery. Surg Endosc. 2013;27(6):2046–51.PubMedCrossRef
43.
DePaula AL, et al. Laparoscopic ileal interposition associated to a diverted sleeve gastrectomy is an effective operation for the treatment of type 2 diabetes mellitus patients with BMI 21–29. Surg Endosc. 2009;23(6):1313–20.PubMedCrossRef
44.
Getty JL, et al. Changes in renal function following Roux-en-Y gastric bypass: a prospective study. Obes Surg. 2012;22(7):1055–9.PubMedCrossRef
45.
Saliba J, et al. Roux-en-Y gastric bypass reverses renal glomerular but not tubular abnormalities in excessively obese diabetics. Surgery. 2010;147(2):282–7.PubMedCrossRef
46.
Zeve JL, et al. Obese patients with diabetes mellitus type 2 undergoing gastric bypass in Roux-en-Y: analysis of results and its influence in complications. Arq Bras Cir Dig. 2013;26(Suppl 1):47–52.PubMedCrossRef
47.
Luaces M, et al. The impact of bariatric surgery on renal and cardiac functions in morbidly obese patients. Nephrol Dial Transplant. 2012;27(Suppl 4): iv53–7.
48.
Jose B, et al. The effect of biliopancreatic diversion surgery on renal function—a retrospective study. Obes Surg. 2013;23(5):634–7.PubMedCrossRef
49.
Mohan S, et al. Early improvement in albuminuria in non-diabetic patients after Roux-en-Y bariatric surgery. Obes Surg. 2012;22(3):375–80.PubMedCrossRef
50.
Navaneethan SD, et al. Urinary albumin excretion, HMW adiponectin, and insulin sensitivity in type 2 diabetic patients undergoing bariatric surgery. Obes Surg. 2010;20(3):308–15.PubMedPubMedCentralCrossRef
51.
Friedman AN, et al. Predicting the glomerular filtration rate in bariatric surgery patients. Am J Nephrol. 2014;39(1):8–15.PubMedCrossRef
52.
53.
Ruiz-Tovar J, et al. Laparoscopic sleeve gastrectomy prevents the deterioration of renal function in morbidly obese patients over 40 years. Obes Surg. 2015;25(5):796–9.PubMedCrossRef
54.
Navarro-Diaz M, et al. Effect of drastic weight loss after bariatric surgery on renal parameters in extremely obese patients: long-term follow-up. J Am Soc Nephrol. 2006;17(12 Suppl 3):S213–7.PubMedCrossRef
55.
Palomar R, et al. Effects of weight loss after biliopancreatic diversion on metabolism and cardiovascular profile. Obes Surg. 2005;15(6):794–8.PubMedCrossRef
56.
57.
Heneghan HM, et al. Effects of bariatric surgery on diabetic nephropathy after 5 years of follow-up. Surg Obes Relat Dis. 2013;9(1):7–14.PubMedCrossRef
58.
Celik F, et al. The longer-term effects of Roux-en-Y gastric bypass surgery on sodium excretion. Obes Surg. 2013;23(3):358–64.PubMedCrossRef
59.
Schuster DP, et al. Effect of bariatric surgery on normal and abnormal renal function. Surg Obes Relat Dis. 2011;7(4):459–64.PubMedCrossRef
60.
Agrawal V, et al. The effect of weight loss after bariatric surgery on albuminuria. Clin Nephrol. 2008;70(3):194–202.PubMedCrossRef
61.
Serpa Neto A, et al. Effect of weight loss after Roux-en-Y gastric bypass, on renal function and blood pressure in morbidly obese patients. J Nephrol. 2009;22(5):637–46.PubMed
62.
Favre G, et al. Longitudinal assessment of renal function in native kidney after bariatric surgery. Surg Obes Relat Dis. 2018;14(9):1411–8.PubMedCrossRef
63.
Thomas DM, Coles GA, Williams JD. What does the renal reserve mean? Kidney Int. 1994;45(2):411–6.PubMedCrossRef
64.
D’Agati VD, et al. Obesity-related glomerulopathy: clinical and pathologic characteristics and pathogenesis. Nat Rev Nephrol. 2016;12(8):453–71.PubMedCrossRef
65.
Kindgen-Milles D, Slowinski T, Dimski T. New kidney function tests: renal functional reserve and furosemide stress test. Med Klin Intensivmed Notfmed. 2020;115(1):37–42.PubMedCrossRef
66.
Sharma A, Mucino MJ, Ronco C. Renal functional reserve and renal recovery after acute kidney injury. Nephron Clin Pract. 2014;127(1–4):94–100.PubMedCrossRef
67.
Metadata
Title
Improvement of Renal Function After Bariatric Surgery: a Systematic Review and Meta-analysis
Authors
Hongyan Huang
Jun Lu
Xiaojiang Dai
Zhixin Li
Liyong Zhu
Shaihong Zhu
Liangping Wu
Publication date
01-10-2021
Publisher
Springer US
Published in
Obesity Surgery / Issue 10/2021
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-021-05630-4

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