Image: A new study shows obesity surgery can protect against kidney disease (Photo courtesy of SA).
A new study shows that bariatric surgery is associated with a long-term protection against end-stage renal disease (ESRD) and chronic kidney disease stage 4 (CKD4).
Researchers at the University of Gothenburg (Sweden), Sahlgrenska Academy (SA; Göteborg, Sweden), and other institutions conducted a prospective study in 4,047 patients participating in the Swedish Obese Subjects (SOS) study. The study cohort, consisting of 2,010 patients, underwent banding (18%), vertical banded gastroplasty (69%), or gastric bypass (13%); the 2,037 patients in the control group received usual obesity care. All patients were followed for a median of 18 years. Incidence of ESRD and CKD4 was obtained by crosschecking the SOS database with the Swedish National Patient Register.
The results showed that ESRD occurred in 13 patients in the surgery group and 26 patients in the control group, with 23 CKD4 events in the surgery group and 39 in the control group. Patients who underwent weight-loss surgery ran a significantly lower risk of developing severe chronic kidney disease and ESRD, when compared to conventionally treated patients. Those with initial evidence of kidney damage--as manifested by macroalbuminuria--benefited the most, indicating that bariatric surgery prevents progression of pre-existing kidney injury towards ESRD. The study was published on February 26, 2018, in the International Journal of Obesity.
“Obesity is a major public health problem leading to co-morbidities such as diabetes, hypertension, and kidney failure. Bariatric surgery results in pronounced and maintained weight loss and prevention of obesity-related diseases and their complications,” concluded senior author Per-Arne Svensson, PhD, of the SA Institute of Health and Care Sciences. “Most studies of bariatric surgery on kidney disease show improvements after surgery. Our study showed for the first time that bariatric surgery is associated with a long-term protection against ESRD and CKD4.”
Kidney disease is usually progressive, with each stage determined by glomerular filtration rate (GFR), and dependent on treatment and response. The kidneys of people with ESRD function below 15% of their normal ability. Chronic kidney disease typically does not reach ESRD, the fifth stage of the progression, until 10-20 years after initial diagnosis, at which time the only treatments left include dialysis or a kidney transplant.
University of Gothenburg