Top

Published in:

01-02-2018 | Original Contributions

Prevalence of Chronic Kidney Disease in Morbidly Obese Japanese and the Impact of Bariatric Surgery on Disease Progression

Authors: Kotaro Wakamatsu, Yosuke Seki, Kazunori Kasama, Kohei Uno, Kenkichi Hashimoto, Yasuyuki Seto, Yoshimochi Kurokawa

Published in: Obesity Surgery | Issue 2/2018

Abstract

Background

The prevalence of chronic kidney disease (CKD) among Japanese morbidly obese patients undergoing bariatric surgery and the impact of bariatric surgery on their renal function has not previously been investigated.

Objectives

The aims were to assess the prevalence of CKD patients who underwent bariatric surgery in our institution and to elucidate the impact of bariatric surgery on their kidney function as measured by the estimated glomerular filtration rate by Cystatin-C (eGFRcys).

Setting

The setting of the study was in a single private hospital.

Methods

Two hundred fifty-four consecutive Japanese patients who underwent bariatric surgery were retrospectively analyzed to elucidate the prevalence of CKD. The eGFRcys was calculated to assess the change in the kidney function for 1 year after surgery.

Results

The preoperative prevalence of CKD was as follows: G1, 45.3%; G2, 47.2%; G3, 6.5%; and G4, 0.9%. The eGFRcys values before and after surgery were compared; the G1 and G2 patients showed significantly improved eGFRcys values after surgery (G1 101 [94–108] vs 114 [103–127]; G2 79 [74–84] vs 97 [87–104] ml/min/1.73 m²; p < 0.01) with significant weight loss (G1 38.1 ± 6.2 vs 26.5 ± 3.4; G2 38.5 ± 6.9 vs 26.7 ± 3.6 kg/m²; p < 0.01). Although the renal function of G3 patients was not improved after surgery (44 [42–47] vs 45 [43–63] ml/min/1.73 m²; p = 0.08), successful weight loss was achieved (36.1 ± 6.3 vs 26.6 ± 3.6 kg/m²; p < 0.01). In multivariate analysis, postoperative eGFRcys correlated negatively with proteinuria (p < 0.01), age (p < 0.01), and body mass index (p < 0.01) and positively with persistence of antihypertensive drugs.

Conclusion

Bariatric surgery resulted in the significant improvement in the eGFRcys values of Japanese patients with morbid obesity, particularly those with pre-CKD (eGFRcys ≥ 60 ml/min/1.73 m²), while the eGFRcys values of CKD patients (< 60 ml/min/1.73 m²) were not ameliorated by surgery.

Imai E, Horio M, Watanabe T, et al. Prevalence of chronic kidney disease in the Japanese general population. Clin Exp Nephrol. 2009;13(6):621–30. doi:10.1007/s10157-009-0199-x.CrossRefPubMed

Ogden CL, Carroll MD, Kit BK, et al. Prevalence of obesity in the United States, 2009-2010. NCHS Data Brief. 2012;82:1–8. http://www.ncbi.nlm.nih.gov/pubmed/22617494. Accessed May 25, 2016

Yoshiike N, Matsumura Y, Zaman MM, et al. Descriptive epidemiology of body mass index in Japanese adults in a representative sample from the National Nutrition Survey 1990-1994. Int J Obes Relat Metab Disord. 1998;22(7):684–7. http://www.ncbi.nlm.nih.gov/pubmed/9705030. Accessed May 25, 2016CrossRefPubMed

Hsu C, McCulloch CE, Iribarren C, et al. Body mass index and risk for end-stage renal disease. Ann Intern Med. 2006;144(1):21–8. http://www.ncbi.nlm.nih.gov/pubmed/16389251. Accessed November 15, 2016CrossRefPubMed

Ix JH, Sharma K. Mechanisms linking obesity, chronic kidney disease, and fatty liver disease: the roles of fetuin-A, adiponectin, and AMPK. J Am Soc Nephrol. 2010;21(3):406–12. doi:10.1681/ASN.2009080820.CrossRefPubMedPubMedCentral

Navaneethan SD, Yehnert H. Bariatric surgery and progression of chronic kidney disease. Surg Obes Relat Dis. 2009;5(6):662–5. doi:10.1016/j.soard.2009.01.006.CrossRefPubMed

Mirajkar N, Bellary S, Ahmed M, 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; doi:10.1016/j.soard.2016.02.024.

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(1):126–33. doi:10.1007/s11695-016-2260-7.CrossRefPubMed

Levey AS, Stevens LA, Schmid CH, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604–12. http://www.ncbi.nlm.nih.gov/pubmed/19414839. Accessed May 26, 2016CrossRefPubMedPubMedCentral

10.

Friedman AN, Moe S, Fadel WF, et al. Predicting the glomerular filtration rate in bariatric surgery patients. Am J Nephrol. 2014;39(1):8–15. doi:10.1159/000357231.CrossRefPubMed

11.

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(4):559–68. doi:10.1016/j.soard.2012.03.009.CrossRefPubMed

12.

Nehus EJ, Khoury JC, Inge TH, et al. Kidney outcomes three years after bariatric surgery in severely obese adolescents. Kidney Int. 2016; doi:10.1016/j.kint.2016.09.031.

13.

Lee W-J, Wang W. Bariatric surgery: Asia-Pacific perspective. Obes Surg. 2005;15(6):751–7. doi:10.1381/0960892054222614.CrossRefPubMed

14.

Horio M, Imai E, Yasuda Y, et al. Collaborators developing the Japanese equation for estimated GFR. GFR estimation using standardized serum cystatin C in Japan. Am J Kidney Dis. 2013;61(2):197–203. doi:10.1053/j.ajkd.2012.07.007.CrossRefPubMed

15.

Matsuo S, Imai E, Horio M, et al. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009;53(6):982–92. doi:10.1053/j.ajkd.2008.12.034.CrossRefPubMed

16.

Levey AS, Becker C, Inker LA. Glomerular filtration rate and albuminuria for detection and staging of acute and chronic kidney disease in adults: a systematic review. JAMA. 2015;313(8):837–46. doi:10.1001/jama.2015.0602.CrossRefPubMedPubMedCentral

17.

Seki Y, Kasama K, Hashimoto K. Long-term outcome of laparoscopic sleeve gastrectomy in morbidly obese Japanese patients. Obes Surg. 2016;26(1):138–45. doi:10.1007/s11695-015-1728-1.CrossRefPubMed

18.

Seki Y, Kasama K, Umezawa A, et al. Laparoscopic sleeve gastrectomy with duodenojejunal bypass for type 2 diabetes mellitus. Obes Surg. 2016; doi:10.1007/s11695-016-2057-8.

19.

Hashimoto K, Seki Y, Kasama K. Laparoscopic intragastric surgery and laparoscopic roux-y gastric bypass were performed simultaneously on a morbidly obese patient with a gastric submucosal tumor: a report of a case and review. Obes Surg. 2015;25(3):564–7. doi:10.1007/s11695-014-1550-1.CrossRefPubMed

20.

Akbari A, Clase CM, Acott P, et al. Canadian Society of Nephrology commentary on the KDIGO clinical practice guideline for CKD evaluation and management. Am J Kidney Dis. 2015;65(2):177–205. doi:10.1053/j.ajkd.2014.10.013.CrossRefPubMed

21.

Matsuzawa Y, Funahashi T, Nakamura T. The concept of metabolic syndrome: contribution of visceral fat accumulation and its molecular mechanism. J Atheroscler Thromb. 2011;18(8):629–39. http://www.ncbi.nlm.nih.gov/pubmed/21737960. Accessed May 25, 2016CrossRefPubMed

22.

Abou-Mrad RM, Abu-Alfa AK, Ziyadeh FN. Effects of weight reduction regimens and bariatric surgery on chronic kidney disease in obese patients. AJP Ren Physiol. 2013;305(5):F613–7. doi:10.1152/ajprenal.00173.2013.CrossRef

23.

Friedman AN, Ogden LG, Foster GD, et al. Comparative effects of low-carbohydrate high-protein versus low-fat diets on the kidney. Clin J Am Soc Nephrol. 2012;7(7):1103–11. doi:10.2215/CJN.11741111.CrossRefPubMedPubMedCentral

24.

Chang AR, Chen Y, Still C, et al. Bariatric surgery is associated with improvement in kidney outcomes. Kidney Int. 2016;90(1):164–71. doi:10.1016/j.kint.2016.02.039.CrossRefPubMedPubMedCentral

25.

Li K, Zou J, Ye Z, et al. Effects of bariatric surgery on renal function in obese patients: a systematic review and meta analysis. Joles JA, ed. PLoS One. 2016;11(10):e0163907. doi:10.1371/journal.pone.0163907.CrossRefPubMedPubMedCentral

26.

Ito R, Yamakage H, Kotani K, et al. Comparison of cystatin C- and creatinine-based estimated glomerular filtration rate to predict coronary heart disease risk in Japanese patients with obesity and diabetes. Endocr J. 2015;62(2):201–7. doi:10.1507/endocrj.EJ14-0352.CrossRefPubMed

27.

Rubino F, Nathan DM, Eckel RH, et al. Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations. Diabetes Care. 2016;39(6):861–77. doi:10.2337/dc16-0236.CrossRefPubMed

Title: Prevalence of Chronic Kidney Disease in Morbidly Obese Japanese and the Impact of Bariatric Surgery on Disease Progression
Authors: Kotaro Wakamatsu
Yosuke Seki
Kazunori Kasama
Kohei Uno
Kenkichi Hashimoto
Yasuyuki Seto
Yoshimochi Kurokawa
Publication date: 01-02-2018
Publisher: Springer US
Published in: Obesity Surgery / Issue 2/2018
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-017-2863-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Prevalence of Chronic Kidney Disease in Morbidly Obese Japanese and the Impact of Bariatric Surgery on Disease Progression

Abstract

Background

Objectives

Setting

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Objectives

Setting

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2018

Comparison of Oral Iron Supplement Formulations for Normalization of Iron Status Following Roux-EN-y Gastric Bypass Surgery: a Randomized Trial

Safety and Efficacy of a New Swallowable Intragastric Balloon Not Needing Endoscopy: Early Italian Experience

Converting a Sleeve Gastrectomy to a Gastric Bypass for Weight Loss Failure—Is It Worth It?

EUS-Guided Transrectal Evacuation of Organized Pelvic Collection Following Roux-en-Y Gastric Bypass After Failure of Radiological and Surgical Approach

Rapid Eating is Linked to Emotional Eating in Obese Women Relieving from Bariatric Surgery

Comment on “Effects of Laparoscopic Roux-en-Y Gastric Bypass for Type 2 Diabetes Mellitus: Comparison of BMI > 30 and < 30 kg/m2”