Abstract: SA-PO365

Impact of Bariatric Surgery on Prognosis of CKD

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 301 CKD: Risk Factors for Incidence and Progression

Authors

  • Friedman, Allon N., Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Thirlby, Richard C, Virginia Mason, Seattle, Washington, United States
  • Wolfe, Bruce M, Oregon Health & Science University, Portland, Oregon, United States
  • Wahed, Abdus S, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • Wang, Junyao, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • Courcoulas, Anita, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
  • Dakin, Gregory, Weill Cornell Medical College, New York, New York, United States
  • Kimmel, Paul L., National Institute of Diabetes and Digestive Kidney Diseases (NIDDK), Bethesda, Maryland, United States
  • Mitchell, James E, NRI, CHASKA, Minnesota, United States
  • Purnell, Jonathan Q., Oregon Health and Science University, Portland, Oregon, United States
  • Le roux, Carel W, University College Dublin, University College Dublin, Ireland
Background

Obesity is linked to the development and progression of chronic kidney disease (CKD) but whether weight reduction through bariatric surgery protects against CKD is poorly understood. Our goal was to assess if bariatric surgery influences the prognostic risk for CKD.

Methods

We studied the patient cohort from Longitudinal Assessment of Bariatric Surgery 2 (LABS-2), which included 2458 adults who underwent bariatric surgery from March 2006 to April 2009 at 10 US hospitals in 6 geographically diverse clinical centers. Participants underwent Roux-en-Y gastric bypass (n=1530), laparoscopic adjustable band (n=523), sleeve gastrectomy (n=52), banded gastric bypass (n=22), or biliopancreatic diversion with duodenal switch (n=17). The primary outcome was prognostic risk for CKD as measured by the Kidney Disease Improving Global Outcomes (KDIG) consortium criteria.

Results

Patients were 79% female and 87% white with a median age of 46 years. Using the KDIGO criteria 41% and 22% of the group classified at moderate prognostic risk for CKD before surgery (n=254, 11.9% of total cohort) had improvement in their risk category at 1 year and 7 years, respectively. In patients with high prognostic risk at baseline (n=73, 3.4% of total cohort) 56% and 29% improved their risk category at 1 and 7 years, respectively. In patients with very high prognostic risk at baseline (n=29, 1.4% of total cohort) 35% and 7% improved their risk category at 1 and 7 years, respectively. The proportion of patients whose prognostic risk category for CKD worsened was minimal (<5%) and only 5 patients developed end stage renal disease during the follow-up period. When year 1 was used as baseline in order to minimize the effect of weight loss on serum creatinine (and thereby influencing CKD prognostic risk), the magnitude of the benefits was reduced though results were qualitatively similar.

Conclusion

Treatment with bariatric surgery was associated with a reduction in the prognostic risk for CKD in a large proportion of patients for up to 7 years, especially in those with high risk at baseline. These findings support the consideration and further study of bariatric surgery as a treatment for CKD in obese patients.

Funding

  • NIDDK Support