Effects of Bariatric Surgery on Renal Function in Obese Patients: A Systematic Review and Meta Analysis

Obesity is an independent risk factor of development and progression of chronic kidney disease (CKD). Data on the benefits of bariatric surgery in obese patients with impaired kidney function have been conflicting. To explore whether there is improvement in glomerular filtration rate (GFR), proteinu...

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Published in:	PloS one Vol. 11; no. 10; p. e0163907
Main Authors:	Li, Kun, Zou, Jianan, Ye, Zhibin, Di, Jianzhong, Han, Xiaodong, Zhang, Hongwei, Liu, Weijie, Ren, Qinggui, Zhang, Pin
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 04-10-2016 Public Library of Science (PLoS)
Subjects:	Adult Analysis Bariatric surgery Bariatric Surgery - methods Biology and Life Sciences Chronic kidney failure Clinical trials Collaboration Development and progression Female Gastrointestinal surgery Glomerular Filtration Rate Humans Hyperfiltration Inulin Inulin - urine Male Medical research Medicine and Health Sciences Meta-analysis Middle Aged Obesity Obesity - physiopathology Obesity - surgery Observational Studies as Topic Patients Physical Sciences Physicians Proteinuria Randomization Randomized Controlled Trials as Topic Renal function Research and Analysis Methods Risk factors Statistical analysis Studies Surgery Systematic review Treatment Outcome Young Adult
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Abstract	Obesity is an independent risk factor of development and progression of chronic kidney disease (CKD). Data on the benefits of bariatric surgery in obese patients with impaired kidney function have been conflicting. To explore whether there is improvement in glomerular filtration rate (GFR), proteinuria or albuminuria after bariatric surgery. We comprehensively searched the databases of MEDLINE, Embase, web of science and Cochrane for randomized, controlled trials and observational studies that examined bariatric surgery in obese subjects with impaired kidney function. Outcomes included the pre- and post-bariatric surgery GFR, proteinuria and albuminuria. In obese patients with hyperfiltration, we draw conclusions from studies using measured GFR (inulin or iothalamate clearance) unadjusted for BSA only. Study quality was evaluated using the Newcastle-Ottawa Scale. 32 observational studies met our inclusion criteria, and 30 studies were included in the meta-analysis. No matter in dichotomous data or in dichotomous data, there were statistically significant reduction in hyperfiltration, albuminuria and proteinuria after bariatric surgery. The main limitation of this meta-analysis is the lack of randomized controlled trials (RCTs). Another limitation is the lack of long-term follow-up. Bariatric surgery could prevent further decline in renal function by reducing proteinuria, albuminuria and improving glomerular hyperfiltration in obese patients with impaired renal function. However, whether bariatric surgery reverses CKD or delays ESRD progression is still in question, large, randomized prospective studies with a longer follow-up are needed.
AbstractList	BACKGROUNDObesity is an independent risk factor of development and progression of chronic kidney disease (CKD). Data on the benefits of bariatric surgery in obese patients with impaired kidney function have been conflicting.OBJECTIVETo explore whether there is improvement in glomerular filtration rate (GFR), proteinuria or albuminuria after bariatric surgery.METHODSWe comprehensively searched the databases of MEDLINE, Embase, web of science and Cochrane for randomized, controlled trials and observational studies that examined bariatric surgery in obese subjects with impaired kidney function. Outcomes included the pre- and post-bariatric surgery GFR, proteinuria and albuminuria. In obese patients with hyperfiltration, we draw conclusions from studies using measured GFR (inulin or iothalamate clearance) unadjusted for BSA only. Study quality was evaluated using the Newcastle-Ottawa Scale.RESULTS32 observational studies met our inclusion criteria, and 30 studies were included in the meta-analysis. No matter in dichotomous data or in dichotomous data, there were statistically significant reduction in hyperfiltration, albuminuria and proteinuria after bariatric surgery.LIMITATIONSThe main limitation of this meta-analysis is the lack of randomized controlled trials (RCTs). Another limitation is the lack of long-term follow-up.CONCLUSIONSBariatric surgery could prevent further decline in renal function by reducing proteinuria, albuminuria and improving glomerular hyperfiltration in obese patients with impaired renal function. However, whether bariatric surgery reverses CKD or delays ESRD progression is still in question, large, randomized prospective studies with a longer follow-up are needed. Obesity is an independent risk factor of development and progression of chronic kidney disease (CKD). Data on the benefits of bariatric surgery in obese patients with impaired kidney function have been conflicting. To explore whether there is improvement in glomerular filtration rate (GFR), proteinuria or albuminuria after bariatric surgery. We comprehensively searched the databases of MEDLINE, Embase, web of science and Cochrane for randomized, controlled trials and observational studies that examined bariatric surgery in obese subjects with impaired kidney function. Outcomes included the pre- and post-bariatric surgery GFR, proteinuria and albuminuria. In obese patients with hyperfiltration, we draw conclusions from studies using measured GFR (inulin or iothalamate clearance) unadjusted for BSA only. Study quality was evaluated using the Newcastle-Ottawa Scale. 32 observational studies met our inclusion criteria, and 30 studies were included in the meta-analysis. No matter in dichotomous data or in dichotomous data, there were statistically significant reduction in hyperfiltration, albuminuria and proteinuria after bariatric surgery. Bariatric surgery could prevent further decline in renal function by reducing proteinuria, albuminuria and improving glomerular hyperfiltration in obese patients with impaired renal function. However, whether bariatric surgery reverses CKD or delays ESRD progression is still in question, large, randomized prospective studies with a longer follow-up are needed. Background Obesity is an independent risk factor of development and progression of chronic kidney disease (CKD). Data on the benefits of bariatric surgery in obese patients with impaired kidney function have been conflicting. Objective To explore whether there is improvement in glomerular filtration rate (GFR), proteinuria or albuminuria after bariatric surgery. Methods We comprehensively searched the databases of MEDLINE, Embase, web of science and Cochrane for randomized, controlled trials and observational studies that examined bariatric surgery in obese subjects with impaired kidney function. Outcomes included the pre- and post-bariatric surgery GFR, proteinuria and albuminuria. In obese patients with hyperfiltration, we draw conclusions from studies using measured GFR (inulin or iothalamate clearance) unadjusted for BSA only. Study quality was evaluated using the Newcastle-Ottawa Scale. Results 32 observational studies met our inclusion criteria, and 30 studies were included in the meta-analysis. No matter in dichotomous data or in dichotomous data, there were statistically significant reduction in hyperfiltration, albuminuria and proteinuria after bariatric surgery. Limitations The main limitation of this meta-analysis is the lack of randomized controlled trials (RCTs). Another limitation is the lack of long-term follow-up. Conclusions Bariatric surgery could prevent further decline in renal function by reducing proteinuria, albuminuria and improving glomerular hyperfiltration in obese patients with impaired renal function. However, whether bariatric surgery reverses CKD or delays ESRD progression is still in question, large, randomized prospective studies with a longer follow-up are needed. Obesity is an independent risk factor of development and progression of chronic kidney disease (CKD). Data on the benefits of bariatric surgery in obese patients with impaired kidney function have been conflicting. To explore whether there is improvement in glomerular filtration rate (GFR), proteinuria or albuminuria after bariatric surgery. We comprehensively searched the databases of MEDLINE, Embase, web of science and Cochrane for randomized, controlled trials and observational studies that examined bariatric surgery in obese subjects with impaired kidney function. Outcomes included the pre- and post-bariatric surgery GFR, proteinuria and albuminuria. In obese patients with hyperfiltration, we draw conclusions from studies using measured GFR (inulin or iothalamate clearance) unadjusted for BSA only. Study quality was evaluated using the Newcastle-Ottawa Scale. 32 observational studies met our inclusion criteria, and 30 studies were included in the meta-analysis. No matter in dichotomous data or in dichotomous data, there were statistically significant reduction in hyperfiltration, albuminuria and proteinuria after bariatric surgery. The main limitation of this meta-analysis is the lack of randomized controlled trials (RCTs). Another limitation is the lack of long-term follow-up. Bariatric surgery could prevent further decline in renal function by reducing proteinuria, albuminuria and improving glomerular hyperfiltration in obese patients with impaired renal function. However, whether bariatric surgery reverses CKD or delays ESRD progression is still in question, large, randomized prospective studies with a longer follow-up are needed. Background Obesity is an independent risk factor of development and progression of chronic kidney disease (CKD). Data on the benefits of bariatric surgery in obese patients with impaired kidney function have been conflicting. Objective To explore whether there is improvement in glomerular filtration rate (GFR), proteinuria or albuminuria after bariatric surgery. Methods We comprehensively searched the databases of MEDLINE, Embase, web of science and Cochrane for randomized, controlled trials and observational studies that examined bariatric surgery in obese subjects with impaired kidney function. Outcomes included the pre- and post-bariatric surgery GFR, proteinuria and albuminuria. In obese patients with hyperfiltration, we draw conclusions from studies using measured GFR (inulin or iothalamate clearance) unadjusted for BSA only. Study quality was evaluated using the Newcastle-Ottawa Scale. Results 32 observational studies met our inclusion criteria, and 30 studies were included in the meta-analysis. No matter in dichotomous data or in dichotomous data, there were statistically significant reduction in hyperfiltration, albuminuria and proteinuria after bariatric surgery. Limitations The main limitation of this meta-analysis is the lack of randomized controlled trials (RCTs). Another limitation is the lack of long-term follow-up. Conclusions Bariatric surgery could prevent further decline in renal function by reducing proteinuria, albuminuria and improving glomerular hyperfiltration in obese patients with impaired renal function. However, whether bariatric surgery reverses CKD or delays ESRD progression is still in question, large, randomized prospective studies with a longer follow-up are needed.
Audience	Academic
Author	Li, Kun Zou, Jianan Di, Jianzhong Ren, Qinggui Zhang, Pin Liu, Weijie Zhang, Hongwei Ye, Zhibin Han, Xiaodong
AuthorAffiliation	3 Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China University Medical Center Utrecht, NETHERLANDS 1 Department of General Surgery, Huadong Hospital Affiliated to Fudan University, Shanghai, China 2 Department of Nephrology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
AuthorAffiliation_xml	– name: University Medical Center Utrecht, NETHERLANDS – name: 3 Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China – name: 1 Department of General Surgery, Huadong Hospital Affiliated to Fudan University, Shanghai, China – name: 2 Department of Nephrology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
Author_xml	– sequence: 1 givenname: Kun surname: Li fullname: Li, Kun organization: Department of General Surgery, Huadong Hospital Affiliated to Fudan University, Shanghai, China – sequence: 2 givenname: Jianan surname: Zou fullname: Zou, Jianan organization: Department of Nephrology, Huadong Hospital Affiliated to Fudan University, Shanghai, China – sequence: 3 givenname: Zhibin surname: Ye fullname: Ye, Zhibin organization: Department of Nephrology, Huadong Hospital Affiliated to Fudan University, Shanghai, China – sequence: 4 givenname: Jianzhong surname: Di fullname: Di, Jianzhong organization: Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China – sequence: 5 givenname: Xiaodong surname: Han fullname: Han, Xiaodong organization: Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China – sequence: 6 givenname: Hongwei surname: Zhang fullname: Zhang, Hongwei organization: Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China – sequence: 7 givenname: Weijie surname: Liu fullname: Liu, Weijie organization: Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China – sequence: 8 givenname: Qinggui surname: Ren fullname: Ren, Qinggui organization: Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China – sequence: 9 givenname: Pin surname: Zhang fullname: Zhang, Pin organization: Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/27701452$$D View this record in MEDLINE/PubMed
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Notes	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Article-2 ObjectType-Feature-1 ObjectType-Review-4 ObjectType-Undefined-3 Conceptualization: KL.Data curation: KL JZ.Formal analysis: KL JZ.Investigation: KL JZ.Methodology: KL JZ ZY.Project administration: KL PZ.Software: JD XH HZ WL QR.Supervision: PZ.Writing – original draft: KL JZ.Writing – review & editing: PZ. Competing Interests: The authors have declared that no competing interests exist.
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Snippet	Obesity is an independent risk factor of development and progression of chronic kidney disease (CKD). Data on the benefits of bariatric surgery in obese... Background Obesity is an independent risk factor of development and progression of chronic kidney disease (CKD). Data on the benefits of bariatric surgery in... BACKGROUNDObesity is an independent risk factor of development and progression of chronic kidney disease (CKD). Data on the benefits of bariatric surgery in... BACKGROUND:Obesity is an independent risk factor of development and progression of chronic kidney disease (CKD). Data on the benefits of bariatric surgery in... Background Obesity is an independent risk factor of development and progression of chronic kidney disease (CKD). Data on the benefits of bariatric surgery in...
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SubjectTerms	Adult Analysis Bariatric surgery Bariatric Surgery - methods Biology and Life Sciences Chronic kidney failure Clinical trials Collaboration Development and progression Female Gastrointestinal surgery Glomerular Filtration Rate Humans Hyperfiltration Inulin Inulin - urine Male Medical research Medicine and Health Sciences Meta-analysis Middle Aged Obesity Obesity - physiopathology Obesity - surgery Observational Studies as Topic Patients Physical Sciences Physicians Proteinuria Randomization Randomized Controlled Trials as Topic Renal function Research and Analysis Methods Risk factors Statistical analysis Studies Surgery Systematic review Treatment Outcome Young Adult
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Title	Effects of Bariatric Surgery on Renal Function in Obese Patients: A Systematic Review and Meta Analysis
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