Boris Hansel1,2,3, Konstantinos Arapis4,5, Diana Kadouch6, Severine Ledoux7,8,9, Muriel Coupaye8,9, Simon Msika7,5, François Vrtovsnik7,9,10, Michel Marre6,7,4, Anne Boutten11, Blandine Cherifi12, Sophie Cambos12, Marie Beslay6, Rodi Courie13, Ronan Roussel6,7,4. 1. Service d'Endocrinologie, Diabétologie et Nutrition, Hôpital Bichat-Claude Bernard, HUPNVS, AP-HP, 46 Rue Henri Huchard, 75018, Paris, France. boris.hansel@aphp.fr. 2. Université Paris Diderot - Sorbonne Paris Cité, Paris, France. boris.hansel@aphp.fr. 3. INSERM, U-1138, Centre de Recherche des Cordeliers, Paris, France. boris.hansel@aphp.fr. 4. INSERM, U-1138, Centre de Recherche des Cordeliers, Paris, France. 5. Service de chirurgie digestive, Hôpital Bichat-Claude Bernard, HUPNVS, AP-HP, Paris, France. 6. Service d'Endocrinologie, Diabétologie et Nutrition, Hôpital Bichat-Claude Bernard, HUPNVS, AP-HP, 46 Rue Henri Huchard, 75018, Paris, France. 7. Université Paris Diderot - Sorbonne Paris Cité, Paris, France. 8. Service des Explorations fonctionnelles, Hôpital Louis Mourier, HUPNVS, AP-HP, Colombes, France. 9. INSERM U-1149, Faculté Bichat, Paris, France. 10. Service de Néphrologie, Hôpital Bichat-Claude Bernard, HUPNVS, AP-HP, Paris, France. 11. Service de Biochimie, Hôpital Bichat-Claude Bernard, HUPNVS, AP-HP, Paris, France. 12. Service d'Endocrinologie-Nutrition, CHU de Bordeaux, USN, Hôpital Haut-Lévêque, Pessac, France. 13. Département d'Hépato-Gastroentérologie et Nutrition, Hôpital Antoine Béclère, AP-HP, Clamart, France.
Abstract
BACKGROUND: Obesity is a risk factor for chronic kidney disease (CKD) and a relative contraindication for renal transplantation. Bariatric surgery (BS) is an option to address this issue but we hypothesize that severe CKD is associated with a loss of efficacy of BS which could justify recommending it at an earlier stage of the CKD. METHODS: A retrospective study (n = 101 patients) to test primarily for differences in weight loss at 6 and 12 months according to estimated glomerular filtration rate categories (eGFR < 30 including patients on dialysis, 30-60, 60-90, and ≥ 90 ml/min/1.73 m2) was performed with multivariate analysis adjusted for sex, age, BMI, surgical procedure, and diabetes. We used a second method to confirm our hypothesis comparing weight loss in patients with stage 4-5 CKD (eGFR < 30 ml/min/1.73 m2, n = 17), and matched controls with eGFR ≥ 90 ml/min/1.73 m2. RESULTS: In the first comparison, the multivariate analysis showed a significant positive association between eGFR and weight loss. However, after exclusion of the subgroup of patients with eGFR < 30 ml/min/1.73 m2, the difference between groups was no more significant. In addition, percent total weight loss (%TWL) was significantly lower in patients with severe CKD compared to controls: - 15% vs - 23% at 6 months (p < 0.01); - 17% vs - 27% at 12 months (p < 0.01). The percent excess weight loss at 1 year reached 47% in patients with stage 4-5 CKD and 68% in controls subjects (p < 0.01). Surgery was a success at 12 months (weight loss > 50% of excess weight) in 38% of advanced CKD and 88% of controls (p < 0.01). CONCLUSION: The efficacy of BS was reduced in patients with advanced CKD. These results support early BS in patients with early-to-moderate CKD.
BACKGROUND: Obesity is a risk factor for chronic kidney disease (CKD) and a relative contraindication for renal transplantation. Bariatric surgery (BS) is an option to address this issue but we hypothesize that severe CKD is associated with a loss of efficacy of BS which could justify recommending it at an earlier stage of the CKD. METHODS: A retrospective study (n = 101 patients) to test primarily for differences in weight loss at 6 and 12 months according to estimated glomerular filtration rate categories (eGFR < 30 including patients on dialysis, 30-60, 60-90, and ≥ 90 ml/min/1.73 m2) was performed with multivariate analysis adjusted for sex, age, BMI, surgical procedure, and diabetes. We used a second method to confirm our hypothesis comparing weight loss in patients with stage 4-5 CKD (eGFR < 30 ml/min/1.73 m2, n = 17), and matched controls with eGFR ≥ 90 ml/min/1.73 m2. RESULTS: In the first comparison, the multivariate analysis showed a significant positive association between eGFR and weight loss. However, after exclusion of the subgroup of patients with eGFR < 30 ml/min/1.73 m2, the difference between groups was no more significant. In addition, percent total weight loss (%TWL) was significantly lower in patients with severe CKD compared to controls: - 15% vs - 23% at 6 months (p < 0.01); - 17% vs - 27% at 12 months (p < 0.01). The percent excess weight loss at 1 year reached 47% in patients with stage 4-5 CKD and 68% in controls subjects (p < 0.01). Surgery was a success at 12 months (weight loss > 50% of excess weight) in 38% of advanced CKD and 88% of controls (p < 0.01). CONCLUSION: The efficacy of BS was reduced in patients with advanced CKD. These results support early BS in patients with early-to-moderate CKD.
Authors: Nicole A Turgeon; Sebastian Perez; Max Mondestin; S Scott Davis; Edward Lin; Sudha Tata; Allan D Kirk; Christian P Larsen; Thomas C Pearson; John F Sweeney Journal: J Am Soc Nephrol Date: 2012-03-01 Impact factor: 10.121
Authors: N G Toapanta-Gaibor; M Suñer-Poblet; M Cintra-Cabrera; M Á Pérez-Valdivia; A Suárez-Benjumea; F M Gonzalez-Roncero; G Bernal-Blanco; J L Rocha-Castilla; M Á Gentil-Govantes Journal: Transplant Proc Date: 2018-03 Impact factor: 1.066