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Urinary sodium excretion after gastric bypass surgery

Artikel i vetenskaplig tidskrift
Författare Neil G. Docherty
Lars Fändriks
Carel W le Roux
Peter Hallersund
Malin Werling
Publicerad i Surgery for Obesity and Related Diseases
Volym 13
Nummer/häfte 9
Sidor 1506-1514
ISSN 1550-7289
Publiceringsår 2017
Publicerad vid Institutionen för kliniska vetenskaper, Avdelningen för gastrokirurgisk forskning och utbildning
Sidor 1506-1514
Språk en
Länkar https://doi.org/10.1016/j.soard.201...
Ämnesord Gastric bypass, Sodium, Urine, Natriuresis, Weight loss, cardiovascular risk-factors, glucagon-like peptide-1, bariatric surgery, natriuretic-peptide, kidney-disease, clinical-trial, glp-1 receptor, blood-pressure, weight-loss, life-style, Surgery
Ämneskategorier Kirurgi, Kardiovaskulär medicin, Gastroenterologi

Sammanfattning

Background: Gut-kidney signaling is implicated in sodium homeostasis and thus blood pressure regulation. Roux-en-Y gastric bypass (RYGB) surgery for morbid obesity confers a pronounced and long-lasting blood pressure lowering effect in addition to significant weight loss. Objectives: We set out to establish whether RYGB is associated with an intrinsic change in urinary sodium excretion that may contribute to the reported blood pressure lowering effects of the procedure. Methods: Five female patients (age range: 28-50 yr) without metabolic or hypertensive co-morbidities were included in a study involving four 24-hour residential visits: once before surgery and 10 days, 3 months, and 20 months after surgery. Creatinine and sodium were measured in fasting plasma samples and 24-hour urine samples and creatinine clearance, estimated glomerular filtration rate, and indices of urinary sodium excretion were calculated. Fasting and 60-minute postprandial blood samples from each study day were assayed for pro-B-type natriuretic peptide (NT-proBNP). Results: Increases in weight-normalized urinary sodium excretion of up to 2.3-fold in magnitude occurred at 20 months after surgery. Median fractional excretion of sodium at 20 months was double that seen before surgery. Fasting NT-proBNP levels were stable or increased (1.5- to 5-fold). Moreover, a small postprandial increase in NT-proBNP was observed after surgery. Conclusions: Renal fractional excretion of sodium is increased after RYGB. A shift toward increased postoperative basal and meal associated levels of NT-proBNP coincides with increased urinary sodium excretion. The data support a working hypothesis that an enhanced natriuretic gut kidney signal after RYGB may be of mechanistic importance in the blood pressure lowering effects of this procedure. (C) 2017 American Society for Metabolic and Bariatric Surgery. All rights reserved.

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