Incidence of end-stage renal disease following bariatric surgery in the Swedish Obese Subjects Study

• Published in: International Journal of Obesity Vol. 42; no. 5; pp. 964 - 973
• Main Authors: Shulman, A., Peltonen, M., Sjöström, C. D., Andersson-Assarsson, J. C., Taube, M., Sjöholm, K., le Roux, C. W., Carlsson, L. M. S., Svensson, P.-A.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.06.2018; Nature Publishing Group
• Subjects: 692/308; 692/699/1585; Banding; Body weight loss; Clinical Medicine; Diabetes mellitus; End-stage renal disease; Epidemiology; Gastric bypass; Gastrointestinal surgery; Health Promotion and Disease Prevention; Hypertension; Incidence; Insulin; Internal Medicine; Kidney diseases; Kidneys; Klinisk medicin; Long-term effects; Medicine; Medicine & Public Health; Metabolic Diseases; Obesity; Patients; Public Health; Renal failure; Surgery; Weight control
• ISSN: 0307-0565; 1476-5497; 1476-5497
• DOI: 10.1038/s41366-018-0045-x

Background Obesity is a major public health problem leading to co-morbidities such as diabetes, hypertension and kidney failure. Bariatric surgery results in pronounced and maintained weight loss and prevention of obesity-related diseases and their complications. Most studies of bariatric surgery on kidney disease show improvements after surgery. However, long-term studies analyzing hard end-points are lacking. Here we report on the long-term effects of bariatric surgery compared to usual obesity care on incidence of end-stage renal disease (ESRD) alone and in combination with chronic kidney disease stage 4 (CKD4/ESRD). Methods 4047 patients were included in the Swedish Obese Subjects (SOS) study. Inclusion criteria were age 37–60 years and BMI ≥ 34 in men and BMI ≥ 38 in women. Patients in the bariatric surgery group ( N  = 2010) underwent banding (18%), vertical banded gastroplasty (69%), or gastric bypass (13%); controls ( N  = 2037) received usual obesity care. In this analysis, patients were followed up for a median time of 18 years. The incidence of ESRD and CKD4 was obtained by crosschecking the SOS database with the Swedish National Patient Register. Results During follow-up, ESRD occurred in 13 patients in the surgery group and in 26 patients in the control group (adjusted hazard ratio (HR) = 0.27; 95% CI 0.12–0.60; p  = 0.001). The number of CKD4/ESRD events was 23 in the surgery group and 39 in the control group (adjusted HR = 0.33; 95% CI 0.18–0.62; p  < 0.001). In both analyses, bariatric surgery had a more favorable effect in patients with baseline serum insulin levels above median compared to those with lower insulin levels (interaction p  = 0.010). Treatment benefit of bariatric surgery was also greater in patients with macroalbuminuria at baseline compared to those without macroalbuminuria (interaction p  < 0.001). Conclusions Our study showed for the first time that bariatric surgery is associated with a long-term protection against ESRD and CKD4/ESRD.