Renal Function and Remission of Hypertension After Bariatric Surgery: a 5-Year Prospective Cohort Study

• Published in: Obesity surgery 2017-03, Vol.27 (3), p.613-619
• Main Authors: Neff, Karl J., Baud, Gregory, Raverdy, Violeta, Caiazzo, Robert, Verkindt, Helene, Noel, Christian, le Roux, Carel W., Pattou, François
• Format: Article
• Language: English
• Subjects: Adult; Banding; Bariatric surgery; Bariatric Surgery - methods; Female; Follow-Up Studies; Gastric Bypass - methods; Gastrointestinal surgery; Humans; Hypertension; Hypertension - complications; Hypertension - physiopathology; Hypertension - surgery; Kidney - physiology; Kidney disease; Kidney Function Tests - adverse effects; Kidneys; Kirurgi; Long term; Male; Medicine; Medicine & Public Health; Middle Aged; Nephrology; Njurmedicin; Obesity; Obesity, Morbid - complications; Obesity, Morbid - physiopathology; Obesity, Morbid - surgery; Original Contributions; Postoperative Period; Prospective Studies; Remission Induction; Renal function; Renal Insufficiency, Chronic - physiopathology; Renal Insufficiency, Chronic - surgery; RYGB; Surgery; Weight Loss - physiology
• ISSN: 0960-8923; 1708-0428; 1708-0428
• DOI: 10.1007/s11695-016-2333-7

Purpose This study examines the effect of Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB) on renal function for at least 5 years post-operatively in a tertiary referral center for bariatric surgery. Materials and Methods This prospective cohort study of patients undergoing RYGB and LAGB measured renal function, blood pressure, and diabetes status pre-operatively and then 1 and 5 years post-operatively. Renal function was assessed using the Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), and Cockcroft-Gault formulae. Hypertension and diabetes were defined by the European Society of Hypertension and European Society of Cardiology joint guidelines and American Diabetes Association guidelines, respectively. A sub-group who had completed 10 years post-operative follow-up was also included. Results Estimated glomerular filtration rate (eGFR) increased over 5 years after RYGB ( N  = 190; 94 ± 2 mL/min/1.73 m 2 to 102 ± 22 mL/min/1.73 m 2 , p  = 0.01) and LAGB ( N  = 271; 88 ± 1 to 93 ± 22 mL/min/1.73 m 2 , p  = 0.02). In a sub-group with up to 10 years post-operative date, this trend was maintained. In patients with renal impairment, eGFR improved over 5 years (52 ± 2 to 68 ± 7 mL/min/1.73 m 2 , p  = 0.01). Remission of hypertension was greater after RYGB than LAGB at 1 year (32 vs. 16 %, p  = 0.008) and at 5 years post-operatively (23 vs. 11 %, p  = 0.02). Conclusions Bariatric surgery stabilizes eGFR post-operatively for at least 5 years. In a sub-group with renal impairment, eGFR is increased in the first post-operative year and this is maintained for up to 5 years. RYGB is an effective procedure in achieving blood pressure control.