Effect Of Bariatric Surgery On Renal Function

Background:Metabolic syndrome(MS)is a syndrome of clinical syndromes characterized by a variety of systemic metabolic disorders,including centripetal obesity,systemic hypertension,insulin resistance and atherosclerotic dyslipidemia,which can cause damage to the kidney to varying degrees.Bariatric surgery can reduce body weight and improve and stabilize kidney function in patients with CKD.At present,the evaluation of improvement of renal function after bariatric surgery is mostly based on the urinary microalbumin/creatinine ratio(ACR)and glomerular filtration rate(GFR).However,the urinary microalbumin(UMA)is the earliest marker of chronic kidney disease(CKD)and a predictor of progression to end-stage renal disease(ESRD).Therefore,UMA is more intuitive than ACR and GFR in predicting the occurrence of CKD and ESRD.In addition,the reports on the assessment of renal function changes based on UMA level changes before and after bariatric surgery are limited or limited to a single surgical procedure.So the assessment of renal function changes by UMA level changes before and after bariatric surgery needs further research and discussion.Objective:To study the changes of UMA and renal function in MS patients before and after bariatric surgery,to clarify the benefits of bariatric surgery on renal function in MS patients,and to roughly evaluate the improvement of various indicators of patients after bariatric surgery.Methods:The data of patients diagnosed with MS and treated with bariatric surgery in the Second Department of Gastrointestinal Surgery of our hospital from January 2018 to December 2021 were collected.Height,weight,BMI,blood pressure,high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),uric acid(UA),blood urea nitrogen(BUN),serum creatinine(Scr),UMA and ACR were recorded before and 3,6,12 months after operation.They were divided into LRYGB group and LSG group according to different operation methods.The changes of various indexes of MS patients in the two groups were compared before and after surgery,and the correlation between the percentage of weight loss and the improvement of e GFR and the changes of urinary microalbumin after bariatric surgery were discussed.Results:For LRYGB group,body weight,BMI,systolic blood pressure,diastolic blood pressure and blood glucose were significantly decreased at 3 months after operation than those before operation(P<0.05);body weight,BMI,systolic blood pressure,diastolic blood pressure and blood glucose were significantly decreased(P<0.05)and HDL-C was significantly increased(P<0.05)at 6 months after operation than those before operation;body weight,BMI,systolic blood pressure,diastolic blood pressure,blood glucose and uric acid were significantly decreased(P<0.05)and HDL-C was significantly increased(P<0.05)at 12 months after operation than those before operation.For LSG group,body weight,BMI,systolic blood pressure and diastolic blood pressure were significantly decreased at 3 months after operation than those before operation(P<0.05);body weight,BMI,systolic blood pressure,diastolic blood pressure and uric acid were significantly decreased(P<0.05)and HDL-C was significantly increased(P<0.05)at 6 months after operation than those before operation;body weight,BMI,systolic blood pressure,diastolic blood pressure and blood glucose were significantly decreased(P<0.05)and HDL-C was significantly increased(P<0.05)at 12 months after operation than those before operation.For LRYGB group,BUN(P=0.015),Scr(P=0.003)and e GFR(P<0.001)at 3 months after operation were significantly lower than those before operation;ACR(P=0.018),Scr(P=0.012)and e GFR(P<0.001)at 6 months after operation were significantly lower than those before operation;e GFR(P<0.001)and UMA(P<0.041)at 12 months after surgery were significantly lower than those before surgery.For LSG group,the BUN(P=0.005)and e GFR(P<0.001)in LSG group at 3 months were significantly lower than those before operation;e GFR at 6 months after surgery(P<0.001)was significantly lower than that before surgery;e GFR at 12 months after surgery(P<0.001)was significantly lower than that before surgery.The percentage of weight loss at 12 months after surgery in the LRYGB group was positively correlated with e GFR improvement(r~2=0.316,P=0.005).The percentage of weight loss at 12 months after surgery in the LSG group was positively correlated with e GFR improvement(r~2=0.253,P=0.024).The postoperative UMA in LRYGB group showed a downward trend(P>0.05),which was significantly decreased at 12 months after operation(P<0.05).In the LSG group,UMA increased within 3 months after surgery(P>0.05),and then decreased(P>0.05).Conclusion:1.Both LRYGB and LSG can significantly improve the abnormalities of body weight,BMI,systolic blood pressure,diastolic blood pressure,uric acid andHDL-C in MS patients.LRYGB was superior in reducing blood glucose compared with both operations;2.The UMA after LRYGB showed a downward trend,while the UMA after LSG increased first and then decreased;3.The greater the degree of weight loss at1 year after bariatric metabolic surgery,the more obvious the improvement effect ofglomerular hyperfiltration status,and The most significant reduction in ACR wasachieved at 6 months after LRYGB;4.For MS patients,bariatric surgery has a positive impact on improving renal function and can significantly reverse renal function in the early stage of renal injury.