| 1. |
- Neff, Karl J., et al.
(author)
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Renal Function and Remission of Hypertension After Bariatric Surgery: a 5-Year Prospective Cohort Study
- 2017
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In: Obesity Surgery. - : Springer Science and Business Media LLC. - 0960-8923 .- 1708-0428. ; 27, s. 613-619
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Journal article (peer-reviewed)abstract
- © 2016, Springer Science+Business Media New York. Purpose: This study examines the effect of Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB) on renal function for at least 5years post-operatively in a tertiary referral center for bariatric surgery. Materials and Methods: This prospective cohort study of patients undergoing RYGB and LAGB measured renal function, blood pressure, and diabetes status pre-operatively and then 1 and 5years post-operatively. Renal function was assessed using the Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), and Cockcroft-Gault formulae. Hypertension and diabetes were defined by the European Society of Hypertension and European Society of Cardiology joint guidelines and American Diabetes Association guidelines, respectively. A sub-group who had completed 10years post-operative follow-up was also included. Results: Estimated glomerular filtration rate (eGFR) increased over 5years after RYGB (N = 190; 94 ± 2mL/min/1.73m2 to 102 ± 22mL/min/1.73m2, p = 0.01) and LAGB (N = 271; 88 ± 1 to 93 ± 22mL/min/1.73m2, p = 0.02). In a sub-group with up to 10years post-operative date, this trend was maintained. In patients with renal impairment, eGFR improved over 5years (52 ± 2 to 68 ± 7mL/min/1.73m2, p = 0.01). Remission of hypertension was greater after RYGB than LAGB at 1year (32 vs. 16%, p = 0.008) and at 5years post-operatively (23 vs. 11%, p = 0.02). Conclusions: Bariatric surgery stabilizes eGFR post-operatively for at least 5years. In a sub-group with renal impairment, eGFR is increased in the first post-operative year and this is maintained for up to 5years. RYGB is an effective procedure in achieving blood pressure control.
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| 2. |
- Raverdy, Violeta, et al.
(author)
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Data-driven subgroups of type 2 diabetes, metabolic response, and renal risk profile after bariatric surgery : a retrospective cohort study
- 2022
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In: The Lancet Diabetes and Endocrinology. - 2213-8587. ; 10:3, s. 167-176
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Journal article (peer-reviewed)abstract
- Background: A novel data-driven classification of type 2 diabetes has been proposed to personalise anti-diabetic treatment according to phenotype. One subgroup, severe insulin-resistant diabetes (SIRD), is characterised by mild hyperglycaemia but marked hyperinsulinaemia, and presents an increased risk of diabetic nephropathy. We hypothesised that patients with SIRD could particularly benefit from metabolic surgery. Methods: We retrospectively related the newly defined clusters with the response to metabolic surgery in participants with type 2 diabetes from independent cohorts in France (the Atlas Biologique de l'Obésite Sévère [ABOS] cohort, n=368; participants underwent Roux-en-Y gastric bypass or sleeve gastrectomy between Jan 1, 2006, and Dec 12, 2017) and Brazil (the metabolic surgery cohort of the German Hospital of San Paulo, n=121; participants underwent Roux-en-Y gastric bypass between April 1, 2008, and March 20, 2016). The study outcomes were type 2 diabetes remission and improvement of estimated glomerular filtration rate (eGFR). Findings: At baseline, 34 (9%) of 368 patients, 314 (85%) of 368 patients, and 17 (5%) of 368 patients were classified as having SIRD, mild obesity-related diabetes (MOD), and severe insulin deficient diabetes (SIDD) in the ABOS cohort, respectively, and in the São Paulo cohort, ten (8%) of 121 patients, 83 (69%) of 121 patients, and 25 (21%) of 121 patients were classified as having SIRD, MOD, and SIDD, respectively. At 1 year, type 2 diabetes remission was reported in 26 (81%) of 32 and nine (90%) of ten patients with SIRD, 167 (55%) of 306 and 42 (51%) of 83 patients with MOD, and two (13%) of 16 and nine (36%) of 25 patients with SIDD, in the ABOS and São Paulo cohorts, respectively. The mean eGFR was lower in patients with SIRD at baseline and increased postoperatively in these patients in both cohorts. In multivariable analysis, SIRD was associated with more frequent type 2 diabetes remission (odds ratio 4·3, 95% CI 1·8–11·2; p=0·0015), and an increase in eGFR (mean effect size 13·1 ml/min per 1·73 m2, 95% CI 3·6–22·7; p=0·0070). Interpretation: Patients in the SIRD subgroup had better outcomes after metabolic surgery, both in terms of type 2 diabetes remission and renal function, with no additional surgical risk. Data-driven classification might help to refine the indications for metabolic surgery.
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| 3. |
- Raverdy, Violeta, et al.
(author)
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Performance of non-invasive tests for liver fibrosis and resolution after bariatric surgery.
- 2024
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In: Metabolism: clinical and experimental. - 1532-8600. ; 153
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Journal article (peer-reviewed)abstract
- The value of non-invasive tests for monitoring the resolution of significant liver fibrosis after treatment is poorly investigated. We compared the performances of six non-invasive tests to predict the resolution of significant fibrosis after bariatric surgery.Participants were individuals with obesity submitted to needle liver biopsy at the time of bariatric surgery, and 12 and/or 60months after surgery. We calculated the fibrosis-4 index (FIB-4), NAFLD fibrosis score (NFS), AST to platelet ratio index (APRI), Hepatic fibrosis score (HFS), Fibrosis NAFLD index (FNI), and Liver risk score (LRS) at each time point, and compared their performances for predicting significant fibrosis (F≥2) and its resolution following surgery.At baseline, 2436 patients had liver biopsy, including 261 (10.7%) with significant fibrosis. Overall, 672 patients had pre- and post-operative biopsies (564 at M12 and 328 at M60). The fibrosis stage decreased at M12 and M60 (p<0.001 vs M0). Resolution of significant fibrosis occurred in 58/121 (47.9%) at M12 and 32/50 (64%) at M60. The mean value of all tests decreased after surgery, except for FIB-4. Performances for predicting fibrosis resolution was higher at M60 than at M12 for all tests, and maximal at M60 for FNI and LRS: area under the curve 0.843 (95%CI 0.71-0.95) and 0.92 (95%CI 0.84-1.00); positive likelihood ratio 3.75 (95% CI 1.33-10.59) and 4.58 (95% CI 1.65-12.70), respectively.Results showed the value and limits of non-invasive tests for monitoring the evolution of liver fibrosis after an intervention. Following bariatric surgery, the best performances to predict the resolution of significant fibrosis were observed at M60 with tests combining liver and metabolic traits, namely FNI and LRS.
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