ASN 2014：减肥手术有益于肾脏

2014年11月11日至16日在宾夕法尼亚举办的美国肾脏病学会(American Society Of Nephrology)肾病周上，来自盖辛格医学中心的研究人员通过研究表明，除了帮助病人减肥外，减肥手术或许可以帮助改善其肾脏功能。

减肥手术对于病态肥胖症患者的体重减轻具有明显的作用，而病态肥胖症患者肾功能衰竭的风险往往会明显增加。目前由于减肥手术诱导的体重减轻对肾功能的效应尚不清楚，因此研究人员在研究中检测了经历减肥手术患者的肾脏功能的健康情况。

随后研究人员对3134名参与者进行了平均2.4年的研究，在减肥手术后第一年，参与者的平均体重由130.1kg降低到了90.9kg，平均体重指数从46.8kg/m2降低到了32.6kg/m2，平均的肾脏功能（肾小球滤过率）从94.8ml/min/1.73m2增加到了99.1 ml/min/1.73m2。随后研究者又发现，个体体重每降低5kg，其肾小球滤过率会增加。0.5ml/min/1.73m2，而体重降低和肾小球滤过率的增加在慢性肾病患者中表现尤为明显。研究者在由108名白蛋白尿组成的病人亚群中研究发现，个体体重降低和患者白蛋白尿的分解直接相关。

研究者Chang指出，肌酸酐是当前用于检测肾脏功能的临床标准，其容易受到个体肌肉量的影响，而个体肌肉量往往会随着体重的剧烈减少而改变；后期还需要进行其它研究来检测肾脏的其它标志物，从而来确定本文的研究结论，并且检测体重减少对于肾脏功能长期的影响。

最后研究人员表示，减肥手术或许可以作为一种新方式来检测体重减少对肾脏功能的影响，本文研究揭示了减肥手术对肾脏疾病患者肾脏功能的有益影响，当然还必须强调促进健康的生活方式来避免病态肥胖症，以及抑制慢性肾脏疾病的发生。

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Weight loss, or bariatric, surgery is highly effective for rapid weight loss in patients with morbid obesity, who are at markedly increased risk for kidney failure. Because the effect of bariatric surgery-induced weight loss on kidney function is unknown, Alex Chang, MD (Geisinger Medical Center) and his colleagues examined the kidney health of patients who underwent bariatric surgery.

A total of 3134 participants were followed for a median of 2.4 years. One year after bariatric surgery, average weight decreased from 130.1 to 90.9 kg, average body mass index decreased from 46.8 to 32.6 kg/m2, and average kidney function (estimated glomerular filtration rate, or eGFR) increased from 94.8 to 99.1 ml/min/1.73m2. Every 5 kg of weight loss was associated with a 0.50 ml/min/1.73m2 increase in eGFR. The association between weight loss and increased eGFR was stronger in patients with chronic kidney disease at the start of the study than in those without. In the subset of 108 patients with albuminuria, or protein excretion in the urine (a marker of kidney dysfunction) at the start of the study, weight loss was associated with resolution of albuminuria.

Dr. Chang noted that the current clinical standard to measure kidney function, creatinine, is influenced by muscle mass, which may change with drastic weight loss. Additional studies using other markers of kidney function are needed to confirm the study's findings and to examine the effect of weight loss on long-term kidney outcomes.....