Impact of rapid weight loss after bariatric surgery on the prevalence of arterial hypertension in severely obese patients with chronic kidney disease

摘要

Background Arterial hypertension (HTN) is one of the most important risk factors for the development and progression of chronic kidney disease (CKD). Rapid weight loss after bariatric interventions has a positive impact on blood pressure levels of hypertensive patients. The aim of our study is to assess the prevalence of HTN in patients with CKD after bariatric surgery (BS). Methods We retrospectively reviewed severely obese patients who underwent BS from 2010 to 2017. We used guidelines of the American College of Cardiology to define HTN. Only patients meeting ACC criteria and the calculation of estimated glomerular filtration rate (eGFR) using CKD epidemiology collaboration study equation preoperatively and at 12-month follow-up were included in the analysis. Results From a total of 2900 patients, 29.13% (845) met the required criteria and had variables for the calculation of eGFR recorded preoperatively. 36.92% (312) had preoperative HTN and s classified as CKD stage >= 2. We observed a predominantly female population 63.83% (203) with mean age of 54.10 +/- 11.58. Patients preoperatively classified in CKD 2, 3a, and 3b exhibited the greatest prevalence reduction of HTN at 12-month follow-up (68.59%,n = 214 vs. 36.59%,n = 114; 16.67%,n = 52 vs. 6.41%,n = 20; 7.69%,n = 24 vs. 1.28%,n = 4;p < 0.0001). A marked improvement in CKD was also observed along with improvement in HTN. The greatest benefit corresponded to patients classified preoperatively in CKD 2, 3a and 3b. A total ofn = 70 (62.5%) patients with HTN were classified as CKD 2 preoperatively compared ton = 55 (49.11%) at 12-month follow-up (p = 0.0436). Similarly,n = 22 (19.64%) patients with HTN were classified preoperatively as CKD 3a compared ton = 7 (6.25%) andn = 12 (10.71%) patients as CKD 3b compared ton = 4 (3.57%) during the same time period (p = 0.0028,p = 0.0379, respectively). Conclusions Rapid weight loss after BS significantly reduces prevalence of HTN in all stages of CKD at 12-month follow-up. Additionally, there was a positive impact on classification of CKD at 12-month follow-up.