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2017 ; 2
(2
): 261-270
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Bariatric Surgery and Kidney-Related Outcomes
#MMPMID28439568
Chang AR
; Grams ME
; Navaneethan SD
Kidney Int Rep
2017[Mar]; 2
(2
): 261-270
PMID28439568
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The prevalence of severe obesity in both the general and the chronic kidney
disease (CKD) populations continues to rise, with more than one-fifth of CKD
patients in the United States having a body mass index of ?35 kg/m(2). Severe
obesity has significant renal consequences, including increased risk of end-stage
renal disease (ESRD) and nephrolithiasis. Bariatric surgery represents an
effective method for achieving sustained weight loss, and evidence from
randomized controlled trials suggests that bariatric surgery is also effective in
improving blood pressure, reducing hyperglycemia, and even inducing diabetes
remission. There is also observational evidence suggesting that bariatric surgery
may diminish the long-term risk of kidney function decline and ESRD. Bariatric
surgery appears to be relatively safe in patients with CKD, with postoperative
complications only slightly higher than in the general bariatric surgery
population. The use of bariatric surgery in patients with CKD might help prevent
progression to ESRD or enable selected ESRD patients with severe obesity to
become candidates for kidney transplantation. However, there are also renal risks
in bariatric surgery, namely, acute kidney injury, nephrolithiasis, and, in rare
cases, oxalate nephropathy, particularly in types of surgery involving higher
degrees of malabsorption. Although bariatric surgery may improve long-term kidney
outcomes, this potential benefit remains unproved and must be balanced with
potential adverse events.
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