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Measurement of glomerular filtration rate in patients undergoing obesity surgery

BACKGROUND: Most studies on obesity surgery have measured renal function using the estimated GFR. However, due to the reduction of muscle mass, and therefore creatinine that accompanies weight loss, such measures can falsely suggest an improvement in renal function. To balance the risks of surgery v...

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Autores principales: Chuah, Ling L., Miras, Alexander D., Perry, Laura M., Frankel, Andrew H., Towey, David J., Al-Mayahi, Zahraa, Svensson, William, le Roux, Carel W.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6311002/
https://www.ncbi.nlm.nih.gov/pubmed/30594245
http://dx.doi.org/10.1186/s12882-018-1188-7
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author Chuah, Ling L.
Miras, Alexander D.
Perry, Laura M.
Frankel, Andrew H.
Towey, David J.
Al-Mayahi, Zahraa
Svensson, William
le Roux, Carel W.
author_facet Chuah, Ling L.
Miras, Alexander D.
Perry, Laura M.
Frankel, Andrew H.
Towey, David J.
Al-Mayahi, Zahraa
Svensson, William
le Roux, Carel W.
author_sort Chuah, Ling L.
collection PubMed
description BACKGROUND: Most studies on obesity surgery have measured renal function using the estimated GFR. However, due to the reduction of muscle mass, and therefore creatinine that accompanies weight loss, such measures can falsely suggest an improvement in renal function. To balance the risks of surgery versus any potential benefits on renal function, we need to be able to determine renal function using valid and reliable methodologies. In this pilot study we aimed to measure renal function in patients with CKD undergoing obesity surgery using the gold standard (51)Cr-EDTA GFR clearance methodology which is independent of measures of muscle mass. METHODS: Nine consecutive obese patients with CKD underwent obesity surgery. Their renal function was assessed using (51)Cr-EDTA GFR, cystatin C and serum creatinine as well as using eGFR equations including MDRD CKD Epi, Cockcroft Gault and CKD Epi cystatin before and 12 months after surgery. RESULTS: Renal function using the (51)Cr-EDTA measured GFR did not change significantly after surgery. Similar results were obtained when Cystatin C, CKD Epi cystatin, CKD Epi cystatin creatinine and adjusted Cockcroft Gault Creatinine clearance methods were used. In contrast there were either trends or significant improvements in renal function measured using the MDRD and CKD Epi equations. CONCLUSIONS: In this pilot study using the gold standard (51)Cr-EDTA method we found stabilisation in renal function after obesity surgery. Until further definitive data emerge it is critical to balance the risk and benefits of surgery, especially if renal function may not improve as often as previously suggested. TRIAL REGISTRATION: ClinicalTrials.gov NCT01507350. Registered June 2011.
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spelling pubmed-63110022019-01-07 Measurement of glomerular filtration rate in patients undergoing obesity surgery Chuah, Ling L. Miras, Alexander D. Perry, Laura M. Frankel, Andrew H. Towey, David J. Al-Mayahi, Zahraa Svensson, William le Roux, Carel W. BMC Nephrol Research Article BACKGROUND: Most studies on obesity surgery have measured renal function using the estimated GFR. However, due to the reduction of muscle mass, and therefore creatinine that accompanies weight loss, such measures can falsely suggest an improvement in renal function. To balance the risks of surgery versus any potential benefits on renal function, we need to be able to determine renal function using valid and reliable methodologies. In this pilot study we aimed to measure renal function in patients with CKD undergoing obesity surgery using the gold standard (51)Cr-EDTA GFR clearance methodology which is independent of measures of muscle mass. METHODS: Nine consecutive obese patients with CKD underwent obesity surgery. Their renal function was assessed using (51)Cr-EDTA GFR, cystatin C and serum creatinine as well as using eGFR equations including MDRD CKD Epi, Cockcroft Gault and CKD Epi cystatin before and 12 months after surgery. RESULTS: Renal function using the (51)Cr-EDTA measured GFR did not change significantly after surgery. Similar results were obtained when Cystatin C, CKD Epi cystatin, CKD Epi cystatin creatinine and adjusted Cockcroft Gault Creatinine clearance methods were used. In contrast there were either trends or significant improvements in renal function measured using the MDRD and CKD Epi equations. CONCLUSIONS: In this pilot study using the gold standard (51)Cr-EDTA method we found stabilisation in renal function after obesity surgery. Until further definitive data emerge it is critical to balance the risk and benefits of surgery, especially if renal function may not improve as often as previously suggested. TRIAL REGISTRATION: ClinicalTrials.gov NCT01507350. Registered June 2011. BioMed Central 2018-12-29 /pmc/articles/PMC6311002/ /pubmed/30594245 http://dx.doi.org/10.1186/s12882-018-1188-7 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Chuah, Ling L.
Miras, Alexander D.
Perry, Laura M.
Frankel, Andrew H.
Towey, David J.
Al-Mayahi, Zahraa
Svensson, William
le Roux, Carel W.
Measurement of glomerular filtration rate in patients undergoing obesity surgery
title Measurement of glomerular filtration rate in patients undergoing obesity surgery
title_full Measurement of glomerular filtration rate in patients undergoing obesity surgery
title_fullStr Measurement of glomerular filtration rate in patients undergoing obesity surgery
title_full_unstemmed Measurement of glomerular filtration rate in patients undergoing obesity surgery
title_short Measurement of glomerular filtration rate in patients undergoing obesity surgery
title_sort measurement of glomerular filtration rate in patients undergoing obesity surgery
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6311002/
https://www.ncbi.nlm.nih.gov/pubmed/30594245
http://dx.doi.org/10.1186/s12882-018-1188-7
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