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Bariatric Surgery

Remission and progression of pre-existing micro- and macroalbuminuria over 15 years after bariatric surgery in Swedish Obese Subjects study

International Journal of Obesity volume 45, pages 535–546 (2021)Cite this article

Subjects

Abstract

Background

Bariatric surgery reduces incidence of albuminuria and end-stage renal disease in patients with obesity. Effects of bariatric surgery on long-term remission and progression of pre-existing obesity-related renal damage are mainly unexplored. Here we investigate the long-term effects of bariatric surgery compared with conventional obesity care on remission and progression of albuminuria.

Methods

4047 patients were included in the Swedish Obese Subjects study. Inclusion criteria were age 37–60 years, BMI ≥ 34 kg/m2 in men and BMI ≥ 38 kg/m2 in women. Our analysis comprised 803 patients (19.8% of total population, 357 control, 446 surgery) with pre-existing albuminuria including 693 patients (312 control, 381 surgery) with microalbuminuria, and 110 patients (45 control, 65 surgery) with macroalbuminuria. Surgery patients were treated with banding, vertical banded gastroplasty, or gastric bypass. Control patients received conventional obesity care.

Results

Total urinary albumin excretion was 36.5% lower in all patients with albuminuria after 15 years, 44.5% lower in patients with microalbuminuria after 15 years, and 27.8% lower in patients with macroalbuminuria after 2 years following bariatric surgery compared with conventional care. In surgery patients with microalbuminuria, remission to normoalbuminuria was higher (OR, 5.9, 2.2, 3.2, p < 0.001) and progression to macroalbuminuria was lower (OR, 0.28, 0.26, 0.25, p ≤ 0.02) at 2, 10, and 15 years, respectively, compared with control patients. In surgery patients with macroalbuminuria remission to normo- or microalbuminuria was higher (OR, 3.67, p = 0.003) after 2 years. No differences between surgery and control patients with macroalbuminuria were observed after 10 and 15 years. Surgery slowed progression of eGFR decline after 2 years in patients with microalbuminuria and macroalbuminuria (treatment effect: 1.0 ml/min/1.73 m2/year, p = 0.001 and 1.4 ml/min/1.73 m2/year, p = 0.047, respectively).

Conclusion

Bariatric surgery had better effects than conventional obesity care on remission of albuminuria and prevention of eGFR decline, indicating that patients with obesity-related renal damage benefit from bariatric surgery.

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Fig. 1: Median U-AER values with 95% confidence intervals.
Fig. 2: Median change in U-AER in percent from baseline with 95% confidence intervals.
Fig. 3: Prevalence of remission and progression of albuminuria with 95% confidence intervals.
Fig. 4: Median eGFR estimated with four-term CKD-EPI formula with 95% confidence intervals.

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Acknowledgements

This study was supported by grants from the Swedish Research Council (2017-01707), the Swedish state under the agreement between the Swedish government and the county councils, the ALF agreement (ALFGBG-717881, ALFGBG-717891), The Swedish Heart-Lung Foundation (20180410), the Novo Nordisk Foundation (NNF19OC0057184), the Swedish Diabetes foundation (2019-417), and the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health (R01DK105948). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    A. Shulman, J. C. Andersson-Assarsson, P. Jacobson, M. Taube, K. Sjöholm, L. M. S. Carlsson & P.-A. Svensson

  2. Clinical Metabolism, Late-stage Development, Cardiovascular, Renal and Metabolism (CVRM), Biopharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden

    C. D. Sjöström

  3. Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland

    C. W. le Roux

  4. Public Health Promotion Unit, National Institute for Health and Welfare, Helsinki, Finland

    M. Peltonen

  5. Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden

    M. Peltonen

  6. Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    P.-A. Svensson

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Contributions

JCAA and MT provided data collection and linkage with the Swedish authorities. MP and JCAA had access to and were responsible for acquisition and integrity of the data. AS was responsible for the statistical data analysis. All authors were responsible for interpretation of the data. AS and PAS drafted the manuscript. All authors participated in critical revision of the manuscript and provided intellectual input. LMSC, PAS, JCAA, KS, and MT were involved in fundraising. All authors approved the final version and agreed to be accountable for all aspects of the work.

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Correspondence to A. Shulman.

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CDS is employed by AstraZeneca. LMSC reports receiving consulting fees from Johnson&Johnson. CWlR serves on advisory boards for Novo Nordisk, GI Dynamics, Keyron, Herbalife, Boehringer Ingelheim, Johnson&Johnson, Sanofi, Consilient Health. Other authors report no conflicts of interest.

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Shulman, A., Andersson-Assarsson, J.C., Sjöström, C.D. et al. Remission and progression of pre-existing micro- and macroalbuminuria over 15 years after bariatric surgery in Swedish Obese Subjects study. Int J Obes 45, 535–546 (2021). https://doi.org/10.1038/s41366-020-00707-z

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