FP309THE EFFECT OF BARIATRIC SURGERY ON RENAL OUTCOMES
Bibliographic record
Abstract
INTRODUCTION AND AIMS: Bariatric surgery (BS) is the most efficient intervention for obtaining and maintaining substantial weight loss and the only method that cures or significantly ameliorates obesity-related comorbidities. BS also seems to have a positive impact on renal function but at the same time BS is associated with hyperoxaluria, nephrolithiasis and oxalate nephropathy. Our systematic review particularly addresses the effects of bariatric surgery on kidney function outcomes in chronic kidney disease (CKD) and non-CKD patients. METHODS: We searched MEDLINE (inception to August 2017), the Cochrane Library (Issue 10 - 12, October 2017) and the website clinicaltrials.gov (August 2017) without language restriction. Hand search for relevant articles was done. A systematic review and meta-analysis was done on observational cohorts studies and randomized controlled trials (RCTs) in adults with obesity that were treated with bariatric surgery for weight loss and have reported data about the impact of bariatric surgery (any techniques) on kidney function endpoints (serum creatinine, creatinine clearance, GFR, proteinuria, nephrolithiasis and need for renal replacement therapy (RRT)). Patients (non-CKD, CKD or transplanted) were included in this analysis if biochemical renal function values were reported before and after BS. Study characteristics and methodological quality was assessed using the Newcastle-Ottawa scale. RESULTS: The final analysis included 23 cohort studies, comprising 3,015 participants. Compared with renal function before treatment, bariatric surgery significantly decreased serum creatinine level (MD -0.08 mg/dL[95% CI, -0.10 to -0.06mg/dL]). BS had also a positive effect on decreasing proteinuria (MD 0.04 g/24h[95% CI, 0.06 to 0.02]) in 6 observational studies that included almost 310 patients. GFR was assessed in 17 out of 23 studies, two studies directly measured GFR through plasma iohexol clearance and inulin clearance, respectively. The other authors estimated GFR. In all studies, GFR significantly improved 6 months or more after BS, irrespective of the surgical method performed and irrespective of the baseline GFR (hyperfiltration or impaired GFR), with three exceptions where GFR either did not change significantly or it decreased. Otherwise, GFR was significantly reduced in hyperfiltration patients and at the same time significantly increased in patients with GFR <90ml/min. The need for RRT was not reported in the included studies. The occurrence of nephrolithiasis was reported inconsistent. CONCLUSIONS: The available evidence, mostly observational, is at moderate risk of bias, and limited by indirect comparisons and inconsistency for some outcomes (eg proteinuria, need for RRT). BS apparently has positive effects on kidney function, including creatinine values, GFR and albuminuria/proteinuria.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.025 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.004 | 0.009 |
| Bibliometrics | 0.005 | 0.005 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.014 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".