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研究背景

根据慢性肾病预后协会（CKD-PC）的数据，每4例年龄≥65岁的患者中就有1例患有某一类型的慢性肾病（CKD），每100例中就有3例进展为肾衰竭。本研究的目的是验证减重手术在CKD进展到肾衰竭中的预防作用。

研究方法

研究人员回顾性分析了近6年来接受减重手术的患者，在术前3个月采用肾小球滤过率（eGFR）和尿白蛋白肌酐比值（uACR）平均值，以评估肾功和肾损伤，随访12个月。数据采用CKD-PC方程式评估CKD进展为肾衰竭的风险。

研究结果

在2924名患者中，2.35%（n=69）具有评估肾脏损伤和进展为肾衰竭风险所需的变量。在CKD的最晚期阶段观察到肾损伤的最大改善，随访12个月uACR下降70.3% （121mg/g，p=0.0154）。这些结果分别对应CKD患者肾衰竭进展中2年和5年的相对风险降低70.03％和60.49％（p=0.001，p=0.001）。

表1 CKD患者进展为肾衰竭的风险降低

研究结论

减重手术可改善CKD严重阶段的肾损伤，这表明在2年和5年从CKD进展到肾衰竭的风险显著降低。

附原文

INTRODUCTION

According to the Chronic Kidney Disease prognosis consortium (CKD-PC), 1 in 4 patients >65 years-of-age, have some form of chronic kidney disease (CKD) and, 3 in 100 progress to kidney failure. The aim of this study is to demonstrate the effect of bariatric surgery in the progression of CKD to kidney failure.

METHODS

Patients who underwent bariatric surgery in the last 6 years were retrospectively reviewed. Kidney function and injury were assessed using estimated glomerular filtration rate (eGFR) and Urinary albumin-to-creatinine ratio (uACR) average value, at a 3-month-interval pre-operatively and at 12 months follow-up. The risk of progression from CKD to kidney failure was assessed using the CKD-PC equation.

RESULTS

Of the 2,924 patients reviewed, 2.35% (n=69) had the required variables to assess kidney injury and risk of progression to kidney failure. The greatest improvement in kidney injury was observed in the most advanced stages of CKD, evidenced by a 70.3% decrease in uACR at 12 months follow-up (121mg/g, p=0.0154). These results correspond to a Relative Risk Reduction of 70.03% and 60.49% at 2 years and 5 years respectively, in the progression to kidney failure in CKD patients (p=0.001, p=0.001).

CONCLUSIONS

Bariatric surgery improves kidney injury in the most severe stages of CKD. This represents a remarkable risk reduction in the progression from CKD to kidney failure at 2 and 5 years. 

来源：ASA官网

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