Abstract
Purpose
Obesity and its associated medical problems increase risk of kidney function decline while prior studies suggest that bariatric surgery may improve kidney outcomes. However, little is known about the comparative effectiveness of different types of bariatric surgery on kidney function. In this study, we compare the effects of laparoscopic one anastomosis gastric bypass (LOAGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB) on kidney function one year after surgery.
Materials and Methods
The patients’ demographic, medical, and surgical data were prospectively collected and retrospectively reviewed. Type 2 diabetes mellitus, hypertension, and dyslipidemia, body mass index (BMI), and kidney function tests were obtained before and one year after surgery. Kidney function was evaluated by estimated glomerular filtration rate (eGFR) and spot urine albumin to creatinine ratio (ACR). Changes in eGFR and ACR were compared between LRYGB vs. LOAGB after adjustment for confounders (age, sex, remission of associated medical problems, preoperative BMI, and percentage of excess BMI loss) using ANCOVA model.
Results
Both surgical techniques significantly decreased the post-surgery presence of diabetes, hypertension, and dyslipidemia (p < 0.001 for all paired comparisons). The eGFR level significantly increased and the ACR level significantly decreased in both groups (p < 0.001 for all paired comparisons before and after adjustment). However, eGFR and ACR mean differences between LRYGB and LOAGB were not significantly different after adjustment for confounding variables (p = 0.9 and 0.4, respectively).
Conclusion
Both LOAGB and LRYGB improved 1-year eGFR and ACR equally independently from weight loss and other confounders.
Similar content being viewed by others
References
Chooi YC, Ding C, Magkos F. The epidemiology of obesity. Metabolism. Elsevier Inc.; 2019;92:6–10. Available from: https://doi.org/10.1016/j.metabol.2018.09.005.
Sayadi Shahraki M, Khalili N, Yousefvand S, Sheikhbahaei E, Shahabi Shahmiri S. Severe obesity and vitamin D deficiency treatment options before bariatric surgery: a randomized clinical trial. Surg Obes Relat Dis. Elsevier Inc.; 2019;15:1604–11. Available from: https://doi.org/10.1016/j.soard.2019.05.033.
Kim DD, Basu A. Estimating the medical care costs of obesity in the United States: systematic review, meta-analysis, and empirical analysis. Value Heal. Elsevier; 2016;19:602–13. Available from: https://doi.org/10.1016/j.jval.2016.02.008.
Rahmani A, Sayehmiri K, Asadollahi K, et al. Investigation of the prevalence of obesity in Iran: a systematic review and meta-analysis study. Acta Med Iran. 2015;53:596–607.
Afshin A, Forouzanfar MH, Reitsma MB, et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017;377:13–27.
Holcomb CN, Goss LE, Almehmi A, et al. Bariatric surgery is associated with renal function improvement. Surg Endosc. Springer US. 2018;32:276–81.
Chang AR, Grams ME, Ballew SH, et al. Adiposity and risk of decline in glomerular filtration rate: meta-analysis of individual participant data in a global consortium. BMJ. 2019;364
Schiavon CA, Bersch-Ferreira AC, Santucci EV, et al. Effects of bariatric surgery in obese patients with hypertension the GATEWAY randomized trial (gastric bypass to treat obese patients with steady hypertension). Circulation. 2018;137:1132–42.
Schiavon CA, Bhatt DL, Ikeoka D, et al. Three-year outcomes of bariatric surgery in patients with obesity and hypertension: a randomized clinical trial. Ann Intern Med. 2020;173:685–93.
Coupaye M, Flamant M, Sami O, Calabrese D, Msika S, Bogard C, et al. Determinants of evolution of glomerular filtration rate after bariatric surgery: a 1-year observational study. Obes Surg. 2017;27:126–33. Available from: https://doi.org/10.1007/s11695-016-2260-7.
D’Agati VD, Chagnac A, De Vries APJ, Levi M, Porrini E, Herman-Edelstein M, et al. Obesity-related glomerulopathy: clinical and pathologic characteristics and pathogenesis. Nat Rev Nephrol. Nature Publishing Group; 2016;12:453–71. Available from: https://doi.org/10.1038/nrneph.2016.75.
Cohen RV, Pereira TV, Aboud CM, et al. Microvascular Outcomes after Metabolic Surgery (MOMS) in patients with type 2 diabetes mellitus and class I obesity: rationale and design for a randomised controlled trial. BMJ Open. 2017;7:e013574.
Robert M, Espalieu P, Pelascini E, et al. Efficacy and safety of one anastomosis gastric bypass versus Roux-en-Y gastric bypass for obesity (YOMEGA): a multicentre, randomised, open-label, non-inferiority trial. Lancet. 2019;393:1299–309.
Cohen RV, Pereira TV, Aboud CM, et al. Effect of gastric bypass vs best medical treatment on early-stage chronic kidney disease in patients with type 2 diabetes and obesity: a randomized clinical trial. JAMA Surg. 2020;155:1–11.
Imam TH, Fischer H, **g B, Burchette R, Henry S, DeRose SF, et al. Estimated GFR before and after bariatric surgery in CKD. Am J Kidney Dis. Elsevier Inc; 2017;69:380–8. Available from: https://doi.org/10.1053/j.ajkd.2016.09.020.
Park S, Kim YJ, Choi CY, et al. Bariatric surgery can reduce albuminuria in patients with severe obesity and normal kidney function by reducing systemic inflammation. Obes Surg. 2018;28:831–7.
Magalhães DSC, Pedro JMP, Souteiro PEB, et al. Analyzing the impact of bariatric surgery in kidney function: a 2-year observational study. Obes Surg. 2019;29:197–206.
Ngoh CLY, So JBY, Tiong HY, Shabbir A, Teo BW. Effect of weight loss after bariatric surgery on kidney function in a multiethnic Asian population. Surg Obes Relat Dis. Elsevier; 2016;12:600–5. Available from: https://doi.org/10.1016/j.soard.2015.07.003.
Hou CC, Shyu RS, Lee WJ, Ser KH, Lee YC, Chen SC. Improved renal function 12 months after bariatric surgery. Surg Obes Relat Dis. Elsevier Inc.; 2013;9:202–6. Available from: https://doi.org/10.1016/j.soard.2012.10.005.
Carbajo MA, Luque-de-León E, Jiménez JM, et al. Laparoscopic one-anastomosis gastric bypass: technique, results, and long-term follow-up in 1200 patients. Obes Surg. 2017;27:1153–67.
Lee WJ, Ser KH, Lee YC, et al. Laparoscopic Roux-en-Y vs. mini-gastric bypass for the treatment of morbid obesity: a 10-year experience. Obes Surg. 2012;22:1827–34.
Spivak H, Munz Y, Rubin M, Raz I, Shohat T, Blumenfeld O. Omega-loop gastric bypass is more effective for weight loss but negatively impacts liver enzymes: a registry-based comprehensive first-year analysis. Surg Obes Relat Dis. Elsevier Inc.; 2018;14:175–80. Available from: https://doi.org/10.1016/j.soard.2017.11.006.
Garcia MS, Calderoni DR, Jimenez LS, et al. Renal function 1 year after bariatric surgery: influence of Roux-en-Y gastric bypass and identification of pre-operative predictors of improvement. Obes Surg. 2020;30:860–6.
Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366:1567–76.
Kim EY, Kim YJ. Does bariatric surgery really prevent deterioration of renal function? Surg Obes Relat Dis. Elsevier; 2016;12:856–61. Available from: https://doi.org/10.1016/j.soard.2015.10.068.
Magouliotis DE, Tasiopoulou VS, Tzovaras G. One anastomosis gastric bypass versus Roux-en-Y gastric bypass for morbid obesity: an updated meta-analysis. Obes Surg. 2019;29:2721–30.
Magouliotis DE, Tasiopoulou VS, Tzovaras G. One anastomosis gastric bypass versus Roux-en-Y gastric bypass for morbid obesity: a meta-analysis. Clin Obes. 2018;8:159–69.
Keleidari B, Mahmoudieh M, Shahabi S, Sheikhbahaei E, Rezaei M, Sayadi M, et al. Reversing one-anastomosis gastric bypass surgery due to severe and refractory hypoalbuminemia. World J Surg. Springer International Publishing; 2020;44:1200–8. Available from: https://doi.org/10.1007/s00268-019-05290-7.
Keleidari B, Mahmoudieh M, Gorgi K, et al. Hepatic failure after bariatric surgery: a systematic review. Hepat Mon. 2019;19:1–16.
Ruiz-Tovar J, Carbajo MA, Jimenez JM, Castro MJ, Gonzalez G, Ortiz-de-Solorzano J, et al. Long-term follow-up after sleeve gastrectomy versus Roux-en-Y gastric bypass versus one-anastomosis gastric bypass: a prospective randomized comparative study of weight loss and remission of comorbidities. Surg Endosc. Springer US; 2019;33:401–10. Available from: https://doi.org/10.1007/s00464-018-6307-9.
Docherty NG, le Roux C. Bariatric surgery for the treatment of chronic kidney disease in obesity and type 2 diabetes mellitus. Nat Rev Nephrol. Springer US; 2020;16:709–20. Available from: https://doi.org/10.1038/s41581-020-0323-4.
Choudhury RA, Hoeltzel G, Prins K, et al. Sleeve gastrectomy compared with gastric bypass for morbidly obese patients with end stage renal disease: a decision analysis. J Gastrointest Surg. 2020;24:756–63.
Bassiony AI, Sabry A, Shiha O, et al. The short-term renal effects of bariatric surgery: a comparative study between sleeve gastrectomy and one anastomosis gastric bypass operations among Egyptian patients with severe obesity. Obes Surg. 2020;30:4494–504.
De Luca M, Tie T, Ooi G, et al. Mini gastric bypass-one anastomosis gastric bypass (MGB-OAGB)—IFSO position statement. Obes Surg. 2018;28:1188–206.
De Luca M, Angrisani L, Himpens J, Busetto L, Scopinaro N, Weiner R, et al. Indications for surgery for obesity and weight-related diseases: position statements from the International Federation for the Surgery of Obesity and metabolic disorders (IFSO). Obes Surg. Obesity Surgery; 2016;26:1659–96. Available from: https://doi.org/10.1007/s11695-016-2271-4.
Keleidari B, Mahmoudieh M, Kafi S, Shahabi S, Sheikhbahaei E, Farahmand A, et al. Which one is better for non-alcoholic fatty liver disease, the Roux-en-Y gastric bypass or one anastomosis gastric bypass? A paired liver biopsy report. Obes Med. Elsevier Ltd; 2020;18:100205. Available from: https://doi.org/10.1016/j.obmed.2020.100205.
Mahmoudieh M, Keleidari B, Afshin N, et al. The early results of the laparoscopic mini-gastric bypass/one anastomosis gastric bypass on patients with different body mass index. J Obes. 2020;2020:1–6.
Mahmoudieh M, Keleidari B, Salimi M, Sayadi M, Shahabi S, Sheikhbahaei E. The two different biliopancreatic limb lengths for Roux-en-Y gastric bypass. Obes Med. Elsevier; 2019;16:100146. Available from: https://doi.org/10.1016/j.obmed.2019.100146.
American Diabetes Association. 2. Classification and diagnosis of diabetes. Diabetes Care. 2015;38:S8-16.
Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34:2159–219.
Sadeghi M, Golshahi J, Talaei M, Sheikhbahaei E, Ghodjani E, Mansouri M, et al. 15-Year lipid profile effects on cardiovascular events adjusted for cardiovascular risk factors: a cohort study from Middle-East. Acta Cardiol. Taylor & Francis; 2020;0:1–6. Available from: https://doi.org/10.1080/00015385.2020.1717096.
Michels WM, Grootendorst DC, Verduijn M, et al. Performance of the Cockcroft-Gault, MDRD, and new CKD-EPI formulas in relation to GFR, age, and body size. Clin J Am Soc Nephrol. 2010;5:1003–9.
Saliba J, Kasim NR, Tamboli RA, Isbell JM, Marks P, Feurer ID, et al. Roux-en-Y gastric bypass reverses renal glomerular but not tubular abnormalities in excessively obese diabetics. Surgery. Mosby, Inc.; 2010;147:282–7. Available from: https://doi.org/10.1016/j.surg.2009.09.017.
Neff KJ, Baud G, Raverdy V, Caiazzo R, Verkindt H, Noel C, et al. Renal function and Remission of hypertension after bariatric surgery: a 5-year prospective cohort study. Obes Surg. Obesity Surgery; 2017;27:613–9. Available from: https://doi.org/10.1007/s11695-016-2333-7.
Friedman AN, Cohen RV. Bariatric surgery as a renoprotective intervention. Curr Opin Nephrol Hypertens. 2019;28:537–44.
Luaces M, Martínez-Martínez E, Medina M, et al. The impact of bariatric surgery on renal and cardiac functions in morbidly obese patients. Nephrol Dial Transplant. 2012;27:iv53–7.
Fenske WK, Dubb S, Bueter M, Seyfried F, Patel K, Tam FWK, et al. Effect of bariatric surgery-induced weight loss on renal and systemic inflammation and blood pressure: a 12-month prospective study. Surg Obes Relat Dis. American Society for Metabolic and Bariatric Surgery; 2013;9:559–68. Available from: https://doi.org/10.1016/j.soard.2012.03.009.
Bilha SC, Nistor I, Nedelcu A, et al. The effects of bariatric surgery on renal outcomes: a systematic review and meta-analysis. Obes Surg. 2018;28:3815–33.
Navaneethan SD, Malin SK, Arrigain S, et al. Bariatric surgery, kidney function, insulin resistance, and adipokines in patients with decreased GFR: A cohort study. Am J Kidney Dis. 2015;65:345–7.
Chang AR, Chen Y, Still C, Wood GC, Kirchner HL, Lewis M, et al. Bariatric surgery is associated with improvement in kidney outcomes. Kidney Int. Elsevier Inc; 2016;90:164–71. Available from: https://doi.org/10.1016/j.kint.2016.02.039.
Reid TJ, Saeed S, McCoy S, Osewa AA, Persaud A, Ahmed L. The effect of bariatric surgery on renal function. Surg Obes Relat Dis. Elsevier; 2014;10:808–13. Available from: https://doi.org/10.1016/j.soard.2014.02.048.
Li K, Zou J, Ye Z, et al. Effects of bariatric surgery on renal function in obese patients: a systematic review and meta analysis. PLoS One. 2016;11:1–18.
Acknowledgments
The authors express their gratitude toward Mr. Amir Salar Moazen Safaei for his kind support through this research.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethical Considerations
All procedures performed in this study were in accordance with the ethical standards of the institutional and national research committee and with 1964 Helsinki declarations and its later amendments. The study commenced after receiving its approval with the registration number of “IR.MUI.MED.REC.1397.223” from the Institutional Review Board of Isfahan University of Medical Sciences.
Informed Consent
Informed consent was obtained before surgery from all individual participants included in the study.
Conflict of Interest
All authors declare no potential conflict of interest.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Mahmoudieh, M., Keleidari, B., Hadipour, P. et al. Comparative Effectiveness of Roux-en-Y Gastric Bypass vs. One Anastomosis Gastric Bypass on Kidney Function. OBES SURG 31, 2464–2470 (2021). https://doi.org/10.1007/s11695-021-05295-z
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-021-05295-z