Estimated GFR Before and After Bariatric Surgery in CKD

Area of Science:

• Nephrology
• Bariatric Surgery
• Metabolic Disease

Background:

• Previous reviews highlight weight loss surgery benefits for kidney function but often lack robust data.
• Existing studies suffer from small sample sizes and limited inclusion of current bariatric procedures.
• Few studies focus on chronic kidney disease (CKD) stages 3 and 4.

Purpose of the Study:

• To evaluate the impact of bariatric surgery on kidney function in patients with CKD stages 3 and 4.
• To compare the effectiveness of Roux-en-Y gastric bypass (RYGB) versus sleeve gastrectomy on estimated glomerular filtration rate (eGFR).

Main Methods:

• Observational retrospective cohort study.
• Propensity score-matching compared bariatric surgery patients (n=714) with non-surgery controls (n=714).
• RYGB and sleeve gastrectomy procedures were individually compared using propensity matching.

Main Results:

• Bariatric surgery patients demonstrated a significant increase in eGFR (9.84 mL/min/1.73m²; 95% CI, 8.05-11.62) compared to controls at 3-year follow-up.
• RYGB patients showed greater eGFR improvement (6.60 mL/min/1.73m²; 95% CI, 3.42-9.78) than sleeve gastrectomy patients over the same period.
• The study included patients with a mean age of 58 years, predominantly women with diabetes and/or hypertension.

Conclusions:

• Bariatric surgery, particularly RYGB, leads to substantial and sustained improvements in eGFR for individuals with CKD stages 3 and 4.
• The findings support bariatric surgery as a viable option for managing kidney function in this patient population.
• Limitations include the nonrandomized design and reliance on estimated GFR, which can be influenced by muscle mass changes.