Bariatric Surgery and Kidney-Related Outcomes.
Bariatric Surgery and Kidney-Related Outcomes.
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DOI：
10.1016/j.ekir.2017.01.010
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发表时间：
2017-03
影响因子：
6
通讯作者：
Navaneethan SD
中科院分区：
文献类型：
--
作者：
Chang AR;Grams ME;Navaneethan SD
严重肥胖在普通人群和慢性肾脏疾病人群中的流行率都在继续上升，美国超过五分之一的慢性肾脏疾病患者的体重指数为≥35公斤/平方米。严重肥胖会导致严重的肾脏后果，包括增加终末期肾病(ESRD)和肾结石的风险。减肥手术是实现持续减肥的有效方法，来自随机对照试验的证据表明，减肥手术在改善血压、降低高血糖，甚至诱导糖尿病缓解方面也是有效的。也有观察证据表明，减肥手术可能会降低肾功能下降和终末期肾病的长期风险。在CKD患者中，减肥手术似乎相对安全，术后并发症仅略高于普通减肥手术人群。在CKD患者中使用减肥手术可能有助于防止进展为终末期肾病，或使选定的严重肥胖的终末期肾病患者成为肾移植的候选对象。然而，减肥手术也有肾脏风险，即急性肾损伤、肾结石，在极少数情况下还会出现草酸肾病，特别是在吸收不良程度较高的手术类型中。虽然减肥手术可能会改善肾脏的长期结果，但这一潜在的益处仍未得到证实，必须与潜在的不良事件相平衡。
The prevalence of severe obesity in both the general and the chronic kidney disease (CKD) populations continues to rise, with more than one-fifth of CKD patients in the United States having a body mass index of ≥35 kg/m2. Severe obesity has significant renal consequences, including increased risk of end-stage renal disease (ESRD) and nephrolithiasis. Bariatric surgery represents an effective method for achieving sustained weight loss, and evidence from randomized controlled trials suggests that bariatric surgery is also effective in improving blood pressure, reducing hyperglycemia, and even inducing diabetes remission. There is also observational evidence suggesting that bariatric surgery may diminish the long-term risk of kidney function decline and ESRD. Bariatric surgery appears to be relatively safe in patients with CKD, with postoperative complications only slightly higher than in the general bariatric surgery population. The use of bariatric surgery in patients with CKD might help prevent progression to ESRD or enable selected ESRD patients with severe obesity to become candidates for kidney transplantation. However, there are also renal risks in bariatric surgery, namely, acute kidney injury, nephrolithiasis, and, in rare cases, oxalate nephropathy, particularly in types of surgery involving higher degrees of malabsorption. Although bariatric surgery may improve long-term kidney outcomes, this potential benefit remains unproved and must be balanced with potential adverse events.