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Bariatric surgery and kidney disease

SOS: Surgery prevents severe chronic kidney disease and failure

The results demonstrate that the patients that underwent bariatric surgery had a significantly lower risk of developing severe chronic kidney disease and kidney failure, when compared to conventionally treated patients

Patients who underwent bariatric surgery ran a significantly lower risk of developing severe chronic kidney disease and failure, when compared to conventionally treated patients, according to the latest paper from the Swedish Obese Subjects (SOS) Study researchers, who reported the incidence of advanced chronic kidney disease among patients in the SOS study.

Most studies of bariatric surgery on kidney disease show improvements after surgery. However, SOS researchers note that there is a lack of long-term studies analysing hard end-points. In their latest analysis, ‘Incidence of end-stage renal disease following bariatric surgery in the Swedish Obese Subjects Study’, published in International Journal of Obesity, they report on the long-term effects of bariatric surgery compared to usual obesity care on incidence of end-stage renal disease (ESRD) alone and in combination with chronic kidney disease stage 4 (CKD4/ESRD).

The SOS study, conducted by Sahlgrenska Academy, recruited 4,047 patients with obesity and they followed for more than 20 years. Inclusion criteria were age 37–60 years and BMI≥34 in men and BMI≥38 in women. Patients in the bariatric surgery group (n=2,010) underwent banding (18%), vertical banded gastroplasty (69%), or gastric bypass (13%); controls (n=2,037) received usual obesity care. In this analysis, patients were followed up for a median time of 18 years. The incidence of ESRD and CKD4 was obtained by crosschecking the SOS database with the Swedish National Patient Register.

Outcomes

The investigators reported that during follow-up, ESRD occurred in 13 patients in the surgery group and in 26 patients in the control group (adjusted hazard ratio (HR) = 0.27; 95% CI 0.12–0.60; p=0.001). The number of CKD4/ESRD events was 23 in the surgery group and 39 in the control group (adjusted HR = 0.33; 95% CI 0.18–0.62; p<0.001). In both analyses, bariatric surgery had a more favourable effect in patients with baseline serum insulin levels above median, compared to those with lower insulin levels (interaction p=0.010). Treatment benefit of bariatric surgery was also greater in patients with macroalbuminuria at baseline compared to those without macroalbuminuria (interaction p<0.001).

Therefore, the results demonstrate that the patients that underwent bariatric surgery had a significantly lower risk of developing severe chronic kidney disease and kidney failure, when compared to conventionally treated patients.

Interestingly, patients with evidence of kidney damage (high levels of protein in the urine) at the start of the study benefited most from surgical treatment, indicating that surgery prevents progression of pre-existing kidney injury towards renal failure. This compliments previous reports from the SOS group which showed that bariatric surgery prevented new-onset kidney injury.

The researchers concluded that these study results showed for the first time that bariatric surgery is associated with a long-term protection against ESRD and CKD4/ESRD and that these findings add to a large body of evidence from the SOS study which demonstrates that bariatric surgery, reduces mortality, improves type 2 diabetes and prevents cardiovascular disease and cancer.

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