Yesterday, I blogged about the fact that obesity may promote the development of kidney disease by making these organs more sensitive to even a moderate increase in blood pressure.
Today, I cite an article by Sankar Navaneethan and Hans Yehnert published in the latest issue of the Surgery for Obesity and Related Diseases (SOARD) suggesting that bariatric surgery may halt and perhaps even reverse progressive loss of renal function in severely obese patients with stage 3 chronic kidney disease (glomerular filtration rate [GFR] 30–59 mL/min/1.73 m2).
In this retrospective study of 25 patients with average BMI at surgery of around 50 and a mean GFR of 47.9 mL/min/1.73 m2, surgery reduced BMI to 38.4 at the end of 6 months and to 34.5 kg/m2at the end of 12 months. This reduction in body weight was accompanied by a significant reduction in blood pressure and an increase in GFR at 6 months to 56.6 and a further increase at 12 months to to 61.6 mL/min/1.73 m2.
These findings are in line with several previous reports of improvement in renal function with weight loss but systematic prospective intervention studies of weight loss in obese patients with impaired renal function are unfortunately still lacking.
Nevertheless, it appears that kidney function may well improve with weight loss and that this treatment option should be considered in obese patients presenting with chronic kidney disease.
AMS
Edmonton, Alberta
In The News
January 19th, 2010 at 4:15 pm
Thank you for the article Dr. Sharma. Can you also comment on bariatric surgery prior to kidney transplant?
January 19th, 2010 at 10:16 pm
There are case reports of bariatric surgery both before and after kidney transplants. It seems to work fine. But remember, these are just single cases and certainly most centres will not have much experience with this - it would have to be a very careful and individual decision in discussion with the responsible physicians and surgeons.