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Incidence of end-stage renal disease following bariatric surgery in the Swedish Obese Subjects Study.

Journal article
Authors Alexander Shulman
Markku Peltonen
C D Sjöström
Johanna C. Andersson-Assarsson
Magdalena Taube
Kajsa Sjöholm
Carel W le Roux
Lena M S Carlsson
Per-Arne Svensson
Published in International journal of obesity
Volume 42
Pages 964–973
ISSN 1476-5497
Publication year 2018
Published at Institute of Health and Care Sciences
Institute of Medicine, Department of Molecular and Clinical Medicine
Pages 964–973
Language en
Subject categories Clinical Medicine


Obesity is a major public health problem leading to co-morbidities such as diabetes, hypertension and kidney failure. Bariatric surgery results in pronounced and maintained weight loss and prevention of obesity-related diseases and their complications. Most studies of bariatric surgery on kidney disease show improvements after surgery. However, long-term studies analyzing hard end-points are lacking. Here we report on the long-term effects of bariatric surgery compared to usual obesity care on incidence of end-stage renal disease (ESRD) alone and in combination with chronic kidney disease stage 4 (CKD4/ESRD).4047 patients were included in the Swedish Obese Subjects (SOS) study. Inclusion criteria were age 37-60 years and BMI ≥ 34 in men and BMI ≥ 38 in women. Patients in the bariatric surgery group (N = 2010) underwent banding (18%), vertical banded gastroplasty (69%), or gastric bypass (13%); controls (N = 2037) received usual obesity care. In this analysis, patients were followed up for a median time of 18 years. The incidence of ESRD and CKD4 was obtained by crosschecking the SOS database with the Swedish National Patient Register.During follow-up, ESRD occurred in 13 patients in the surgery group and in 26 patients in the control group (adjusted hazard ratio (HR) = 0.27; 95% CI 0.12-0.60; p = 0.001). The number of CKD4/ESRD events was 23 in the surgery group and 39 in the control group (adjusted HR = 0.33; 95% CI 0.18-0.62; p < 0.001). In both analyses, bariatric surgery had a more favorable effect in patients with baseline serum insulin levels above median compared to those with lower insulin levels (interaction p = 0.010). Treatment benefit of bariatric surgery was also greater in patients with macroalbuminuria at baseline compared to those without macroalbuminuria (interaction p < 0.001).Our study showed for the first time that bariatric surgery is associated with a long-term protection against ESRD and CKD4/ESRD.

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