Through its direct adverse effects on the kidney and via associated intermediate disease states like type 2 diabetes and hypertension, obese has arguably become the master risk factor for chronic kidney disease (CKD). The purpose of this review is to critically evaluate bariatric surgery, which is the most effective weight reduction strategy available, as a renoprotective strategy.
Recent randomized studies confirm that bariatric surgery is effective at improving or even remitting major CKD risk factors such as type 2 diabetes and hypertension. In addition, observational studies performed primarily in patients without preexisting CKD report improvements in estimated glomerular filtration rate and albuminuria after bariatric surgery. Yet this literature is limited by study design, participant selection, statistical power, and measurement issues that must be overcome to better define kidney-related benefits, especially with regard to harder kidney-related and other clinical endpoints.
Encouraging data exist on the renoprotective effects of bariatric surgery. However, important knowledge gaps still remain. Future research should focus on studying, ideally in randomized fashion, the renoprotective effects of bariatric surgery in patients with preexisting CKD to better define the benefit–risk ratio for each patient.
aDepartment of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
bThe Center for Obesity and Diabetes, Oswaldo Cruz German Hospital, São Paulo, Brazil
Correspondence to Allon N. Friedman, 550 University Blvd., Suite 6100, Indianapolis, IN 46202, USA. Fax: +1 317 948 9419; fax: +1 317 944 4319; e-mail: firstname.lastname@example.org