Obesity and perioperative acute kidney injury: a focused review

Area of Science:

• Nephrology
• Metabolic Disorders
• Surgical Outcomes

Background:

• Obesity is a global epidemic and a major risk factor for cardiovascular disease, hypertension, diabetes mellitus, and chronic kidney disease.
• New diagnostic criteria for kidney dysfunction, such as the Acute Kidney Injury Network (AKIN) and Risk-Injury-Failure-Loss End-stage kidney disease (RIFLE) criteria, have renewed interest in perioperative renal dysfunction.
• Traditional obesity metrics like body mass index (BMI) are increasingly questioned for accurately reflecting visceral obesity and classifying metabolically healthy individuals.

Purpose of the Study:

• To review the epidemiologic and pathophysiologic aspects of obesity.
• To examine the structural and functional changes in kidney function related to obesity.
• To investigate the impact of obesity on perioperative outcomes, including the obesity paradox.

Main Methods:

• Literature review of epidemiologic and pathophysiologic studies on obesity.
• Analysis of the role of visceral adipose tissue and adipokines in obesity.
• Evaluation of diagnostic criteria for kidney dysfunction.
• Review of studies investigating the obesity paradox and perioperative outcomes.

Main Results:

• Increasing evidence links visceral adipose tissue and adipokines to obesity pathophysiology.
• The "obesity paradox" suggests obese patients may have better perioperative outcomes.
• Traditional BMI may not accurately represent visceral obesity or metabolic health.

Conclusions:

• Obesity presents complex challenges in understanding kidney function and surgical outcomes.
• Further research is needed to clarify the mechanisms behind the obesity paradox and its clinical implications.
• Accurate assessment of obesity, beyond BMI, is crucial for patient classification and perioperative management.