title: Bariatric surgery is associated with improvement in kidney outcomes.
abstract: Severe obesity is associated with increased risk of kidney disease. Whether bariatric surgery reduces the risk of adverse kidney outcomes is uncertain. To resolve this we compared the risk of estimated glomerular filtration rate (eGFR) decline of ≥30% and doubling of serum creatinine or end-stage renal disease (ESRD) in 985 patients who underwent bariatric surgery with 985 patients who did not undergo such surgery. Patients were matched on demographics, baseline body mass index, eGFR, comorbidities, and previous nutrition clinic use. Mean age was 45 years, 97% were white, 80% were female, and 33% had baseline eGFR <90 ml/min per 1.73 m(2). Mean 1-year weight loss was 40.4 kg in the surgery group compared with 1.4 kg in the matched cohort. Over a median follow-up of 4.4 years, 85 surgery patients had an eGFR decline of ≥30% (22 had doubling of serum creatinine/ESRD). Over a median follow-up of 3.8 years, 177 patients in the matched cohort had an eGFR decline of ≥30% (50 had doubling of serum creatinine/ESRD). In adjusted analysis, bariatric surgery patients had a significant 58% lower risk for an eGFR decline of ≥30% (hazard ratio 0.42, 95% confidence interval 0.32-0.55) and 57% lower risk of doubling of serum creatinine or ESRD (hazard ratio 0.43, 95% confidence interval: 0.26-0.71) compared with the matched cohort. Results were generally consistent among subgroups of patients with and without eGFR <90 ml/min per 1.73 m(2), hypertension, and diabetes. Thus, bariatric surgery may be an option to prevent kidney function decline in severely obese individuals.
authors.affiliation: Division of Nephrology, Geisinger Health System, Danville, Pennsylvania, USA. Electronic address: achang@geisinger.edu.
authors.forename: Alex R
authors.initials: AR
authors.lastname: Chang
authors.affiliation: Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Obesity Institute, Geisinger Health System, Danville, Pennsylvania, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Still
authors.affiliation: Obesity Institute, Geisinger Health System, Danville, Pennsylvania, USA.
authors.forename: G Craig
authors.initials: GC
authors.lastname: Wood
authors.affiliation: Biomedical & Translational Informatics, Geisinger Health System, Danville, Pennsylvania, USA.
authors.forename: H Lester
authors.initials: HL
authors.lastname: Kirchner
authors.affiliation: Biomedical & Translational Informatics, Geisinger Health System, Danville, Pennsylvania, USA.
authors.forename: Meredith
authors.initials: M
authors.lastname: Lewis
authors.affiliation: Division of Nephrology, Loyola University Medical Center, Chicago, Illinois, USA.
authors.forename: Holly
authors.initials: H
authors.lastname: Kramer
authors.affiliation: Division of Nephrology, Geisinger Health System, Danville, Pennsylvania, USA.
authors.forename: James E
authors.initials: JE
authors.lastname: Hartle
authors.affiliation: Biomedical & Translational Informatics, Geisinger Health System, Danville, Pennsylvania, USA.
authors.forename: David
authors.initials: D
authors.lastname: Carey
authors.affiliation: Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA; Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Appel
authors.affiliation: Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA; Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Morgan E
authors.initials: ME
authors.lastname: Grams
mesh_terms: D000328:Adult; D050110:Bariatric Surgery; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000209:etiology; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000517:prevention & control; D007677:Kidney Function Tests; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D015995:Prevalence; D016016:Proportional Hazards Models; D012307:Risk Factors
chemical_list: D003404:Creatinine
keywords: GFR; Roux-en-Y surgery; bariatric surgery; gastric bypass; glomerular filtration rate; kidney function; morbid obesity; weight loss