Effects of bariatric surgery on renal function: a retrospective cohort study comparing one-year outcomes between one-anastomosis gastric bypass and Roux-en-Y gastric bypass

Ivano, Victor Kenzo; Hatto, Marcelo; Teramoto, Fernanda; Macedo, Paolla Ravida Alves de; Gestic, Martinho Antonio; Utrini, Murillo Pimentel; Chaim, Felipe David Mendonça; Ramos, Almino Cardoso; Callejas-Neto, Francisco; Chaim, Elinton Adami; Cazzo, Everton

doi:10.1590/1516-3180.2023.0161.R1.08022024

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Sao Paulo Medical Journal

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Original Article • Sao Paulo Med. J. 142 (5) • 2024 • https://doi.org/10.1590/1516-3180.2023.0161.R1.08022024 copy

Effects of bariatric surgery on renal function: a retrospective cohort study comparing one-year outcomes between one-anastomosis gastric bypass and Roux-en-Y gastric bypass

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND:

Evidence on the effect of one-anastomosis gastric bypass (OAGB) on renal function is limited.

OBJECTIVE:

To compare the evolution of estimated renal function observed 1 year after OAGB and Roux-en-Y gastric bypass (RYGB) in individuals with obesity.

DESIGN AND SETTING:

Observational, analytical, and retrospective cohort study. Tertiary-level university hospital.

METHODS:

This study used a prospectively collected database of individuals who consecutively underwent bariatric surgery. Renal function was assessed by calculating the estimated glomerular filtration rate (eGFR), according to the Chronic Kidney Disease Epidemiology Collaboration. The one-year variation in the eGFR was compared between the procedures.

RESULTS:

No significant differences in age, sex, obesity-associated conditions, or body mass index were observed among individuals who underwent either OAGB or RYGB. OAGB led to a significantly higher percentage of total (P = 0.007) and excess weight loss (P = 0.026). Both OAGB and RYGB led to significantly higher values of eGFR (103.9 ± 22 versus 116.1 ± 13.3; P = 0.007, and 102.4 ± 19 versus 113.2 ± 13.3; P < 0.001, respectively). The one-year variation in eGFR was 11 ± 16.2% after OAGB and 16.7 ± 26.3% after RYGB (P = 0.3). Younger age and lower baseline eGFR were independently associated with greater postoperative improvement in renal function (P < 0.001).

CONCLUSION:

Compared with RYGB, OAGB led to an equivalent improvement in renal function 1 year after the procedure, along with greater weight loss.

KEYWORDS (MeSH terms):
Gastric bypass; Bariatric surgery; Glomerular filtration rate; Kidney diseases; Obesity

AUTHOR KEYWORDS:
One-anastomosis gastric bypass; Roux-en-Y gastric bypass; Renal function

		OAGB	RYGB	P value
N		46	100	NA
Age (years)		37.4 ± 8	39.2 ± 9.6	0.28
Sex		Male: 5 (10.9%) Female: 41 (89.1%)	Male: 14 (14%) Female: 86 (86%)	0.60
Preoperative BMI (kg/m²2 Fritz J, Brozek W, Concin H, et al. The association of excess body weight with risk of ESKD is mediated through insulin resistance, hypertension, and hyperuricemia. J Am Soc Nephrol. 2022;33(7):1377-89. PMID: 35500938; https://doi.org/10.1681/asn.2021091263. https://doi.org/10.1681/asn.2021091263... )		38.3 ± 5.4	37.3 ± 3.7	0.22
Postoperative BMI (kg/m²2 Fritz J, Brozek W, Concin H, et al. The association of excess body weight with risk of ESKD is mediated through insulin resistance, hypertension, and hyperuricemia. J Am Soc Nephrol. 2022;33(7):1377-89. PMID: 35500938; https://doi.org/10.1681/asn.2021091263. https://doi.org/10.1681/asn.2021091263... )		27 ± 3.9	28.4 ± 4.5	0.07
%TWL		26.9 ± 10.3%	21.4 ± 11.3%	0.007
%EWL		87.4 ± 30.7%	72.5 ± 38.5%	0.026
Preoperative glucose (mg/dL)		87.8 ± 14.7	91.6 ± 20.3	0.27
Postoperative glucose (mg/dL)		82 ± 8.5	81.8 ± 10	0.92
% Δ Glucose		−6.4 ± 15%	−6.9±15.5%	0.89
Preoperative creatinine (mg/dL)		0.8 ± 0.2	0.8 ± 0.2	0.99
Postoperative creatinine (mg/dL)		0.6 ± 0.1	0.6 ± 0.1	0.54
% Δ Creatinine		−14.6 ± 14.3%	−17 ± 20.5%	0.59
Preoperative urea (mg/dL)		24.7 ± 9.8	26.6 ± 9.8	0.29
Postoperative urea (mg/dL)		25.6 ± 6.8	25.1 ± 7	0.82
% Δ Urea		2.9 ± 20.9%	−4.7 ± 26.5%	0.39
Preoperative eGFR (mL/min/1.73m²)		103.9 ± 22	102.4 ± 19	0.69
Postoperative eGFR (mL/min/1.73m²)		116.1 ± 13.3	113.2 ± 13.3	0.33
% Δ eGFR		11 ± 16.2%	16.7 ± 26.3%	0.30
Preoperative obesity-associated conditions
	Type 2 diabetes – N (%)	15 (32.6%)	23 (23%)	0.22
	Hypertension – N (%)	19 (41.3%)	44 (44%)	0.76
Postoperative obesity-associated conditions
	Type 2 diabetes – N (%)	1 (2.2%)	6 (6%)	0.31
	Hypertension – N (%)	3 (6.5%)	9 (9%)	0.64
Diabetes remission rate (%)		93.3%	73.9%	0.13
Hypertension remission rate (%)		84.2%	79.5%	0.67

One-anastomosis gastric bypass (n = 46)
	Preoperative	Postoperative	P value
BMI (kg/m²2 Fritz J, Brozek W, Concin H, et al. The association of excess body weight with risk of ESKD is mediated through insulin resistance, hypertension, and hyperuricemia. J Am Soc Nephrol. 2022;33(7):1377-89. PMID: 35500938; https://doi.org/10.1681/asn.2021091263. https://doi.org/10.1681/asn.2021091263... )	38.3 ± 5.4	27 ± 3.9	<0.001
Glucose (mg/dL)	87.8 ± 14.7	82 ± 8.5	0.047
Creatinine (mg/dL)	0.8 ± 0.2	0.6 ± 0.1	0.001
Urea (mg/dL)	24.7 ± 9.8	25.6 ± 6.8	0.75
eGFR (mL/min/1.73m²)	103.9 ± 22	116.1 ± 13.3	0.007
AST (IU/L)	23.2 ± 9.6	23.8 ± 11.3	0.82
ALT (IU/L)	30.6 ± 24.2	27.2 ± 15.2	0.53
Hemoglobin (g/dL)	13.9 ± 1.1	13 ± 1.1	0.002
Ferritin (μg/L)	185.9 ± 103.2	94.2 ± 112.4	0.03
Serum iron (μg/dL)	69.1 ± 16.1	89.5 ± 32.9	0.08
Albumin (g/dL)	4.3 ± 0.3	4.1 ± 0.3	0.01
Roux-em-Y gastric bypass (n = 100)
BMI (kg/m²2 Fritz J, Brozek W, Concin H, et al. The association of excess body weight with risk of ESKD is mediated through insulin resistance, hypertension, and hyperuricemia. J Am Soc Nephrol. 2022;33(7):1377-89. PMID: 35500938; https://doi.org/10.1681/asn.2021091263. https://doi.org/10.1681/asn.2021091263... )	37.3 ± 3.7	28.4 ± 4.5	<0.001
Glucose (mg/dL)	91.6 ± 20.3	81.8 ± 10	0.002
Creatinine (mg/dL)	0.8 ± 0.2	0.6 ± 0.1	<0.0001
Urea (mg/dL)	26.6 ± 9.8	25.1 ± 7	0.39
eGFR (mL/min/1.73m²)	102.4 ± 19	113.2 ± 13.3	<0.0001
AST (IU/L)	21.8 ± 7.3	22.8 ± 19.9	0.64
ALT (IU/L)	26.7 ± 16.1	26.6 ± 40.9	0.99
Hemoglobin (g/dL)	13.9 ± 1.3	13.1 ± 1.3	0.01
Ferritin (μg/L)	233.9 ± 249.3	138.8 ± 149	0.01
Serum iron (μg/dL)	71.2 ± 28.7	83 ± 38.1	0.08
Albumin (g/dL)	4.3 ± 0.3	4.1 ± 0.3	<0.0001

Univariate analysis (simple regression)
Variable	Regression coefficient	P value
Age	0.20	0.07
BL BMI	0.07	0.41
%TWL	0.18	0.12
%EWL	0.17	0.14
BL glucose	0.13	0.26
BL insulin	−0.35	0.81
BL creatinine	0.80	<0.001
BL urea	0.14	0.74
BL albumin	0.03	0.77
BL hemoglobin A1c	0.06	0.69
BL eGFR	−0.85	<0.001
Multivariate analysis (multiple regression)
Age	−0.31	<0.001
BL creatinine	−0.16	0.25
BL eGFR	−0.99	<0.001

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[1] Address for correspondence: Everton Cazzo Departamento de Cirurgia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP) Rua Alexander Fleming, s/nº Cidade Universitária Zeferino Vaz — Campinas (SP) — Brasil. CEP 13085-000 Phone/fax: +551935219450 E-mail: notrevezzo@yahoo.com.br