Renal Dysfunction Phenotypes in Patients Undergoing Obesity Surgery

• Published in: Biomolecules (Basel, Switzerland) Switzerland), 2023-05, Vol.13 (5), p.790
• Main Authors: Pereira, Pedro R, Pereira, João, Braga, Patrícia C, Pereira, Sofia S, Nora, Mário, Guimarães, Marta, Monteiro, Mariana P, Rodrigues, Anabela
• Format: Article
• Language: English
• Subjects: albuminuria; Albuminuria - etiology; Bariatric Surgery - adverse effects; Body mass index; Care and treatment; Cholesterol; Creatinine; Diabetes; Diabetes mellitus; fatty kidney; Gastrointestinal surgery; Glomerular Filtration Rate; Glycated Hemoglobin; Hemoglobin; High density lipoprotein; Humans; Hypertension; Hyperuricemia; Inflammatory diseases; Kidney diseases; Kidney Diseases - complications; Kidney failure; Lipids; Lipoproteins (very low density); Low density lipoprotein; Medical research; Medicine, Experimental; Metabolic disorders; Metformin; Multivariate analysis; Obesity; Obesity - complications; Obesity - surgery; obesity-related glomerulopathy; Patients; Phenotype; Phenotypes; Prediabetic State; Proteins; Proteinuria; Proteinuria - etiology; Renal function; Risk factors; Statistical analysis; Surgery; Triglycerides; Uric acid; Urine
• ISSN: 2218-273X; 2218-273X
• DOI: 10.3390/biom13050790

Obesity surgery candidates are at an increased risk of kidney injury, but pre-operative evaluation usually neglects kidney function assessment. This study aimed to identify renal dysfunction in candidates for bariatric surgery. To reduce the sources of bias, subjects with diabetes, prediabetes under metformin treatment, neoplastic or inflammatory diseases were excluded. Patients' (n = 192) average body mass index was 41.7 ± 5.4 kg/m . Among these, 51% (n = 94) had creatinine clearance over 140 mL/min, 22.4% (n = 43) had proteinuria over 150 mg/day and 14.6% (n = 28) albuminuria over 30 mg/day. A creatinine clearance higher than 140 mL/min was associated with higher levels of proteinuria and albuminuria. Univariate analysis identified sex, glycated hemoglobin, uric acid, HDL and VLDL cholesterol as being associated with albuminuria, but not with proteinuria. On multivariate analysis, glycated hemoglobin and creatinine clearance as continuous variables were significantly associated with albuminuria. In summary, in our patient population prediabetes, lipid abnormalities and hyperuricemia were associated with albuminuria, but not with proteinuria, suggesting different disease mechanisms might be implicated. Data suggest that in obesity-associated kidney disease, tubulointerstitial injury precedes glomerulopathy. A significant proportion of obesity surgery candidates present clinically relevant albuminuria and proteinuria along with renal hyperfiltration, suggesting that routine pre-operative assessment of these parameters should be considered.