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Kidney stones are common after bariatric surgery.

Lieske JC, Mehta RA, Milliner DS, Rule AD, Bergstralh EJ, Sarr MG - Kidney Int. (2014)

Bottom Line: Obesity, a risk factor for kidney stones and chronic kidney disease (CKD), is effectively treated with bariatric surgery.The risk of CKD significantly increased after the malabsorptive procedures (adjusted hazard ratio of 1.96).Thus, while RYGB and malabsorptive procedures are more effective for weight loss, both are associated with increased risk of stones, while malabsorptive procedures also increase CKD risk.

View Article: PubMed Central - PubMed

Affiliation: 1] Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA [2] Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.

ABSTRACT
Obesity, a risk factor for kidney stones and chronic kidney disease (CKD), is effectively treated with bariatric surgery. However, it is unclear whether surgery alters stone or CKD risk. To determine this we studied 762 Olmsted County, Minnesota residents who underwent bariatric surgery and matched them with equally obese control individuals who did not undergo surgery. The majority of bariatric patients underwent standard Roux-en-Y gastric bypass (RYGB; 78%), with the remainder having more malabsorptive procedures (very long limb RYGB or biliopancreatic diversion/duodenal switch; 14%) or restrictive procedures (laparoscopic banding or sleeve gastrectomy; 7%). The mean age was 45 years with 80% being female. The mean preoperative body mass index (BMI) was 46.7 kg/m(2) for both cohorts. Rates of kidney stones were similar between surgery patients and controls at baseline, but new stone formation significantly increased in surgery patients (11.0%) compared with controls (4.3%) during 6.0 years of follow-up. After malabsorptive and standard surgery, the comorbidity-adjusted hazard ratio of incident stones was significantly increased to 4.15 and 2.13, respectively, but was not significantly changed for restrictive surgery. The risk of CKD significantly increased after the malabsorptive procedures (adjusted hazard ratio of 1.96). Thus, while RYGB and malabsorptive procedures are more effective for weight loss, both are associated with increased risk of stones, while malabsorptive procedures also increase CKD risk.

No MeSH data available.


Related in: MedlinePlus

Changes in urine oxalate and CaOx SS after surgeryPanel A: Urinaryoxalate increased subtly in all cases over time after bariatric surgery (◆ solid diamonds, - - - - dashed line), and more dramatically in those that developed stones (Δ open triangles, —— solid line). Mean urine oxalate was at the upper limit of the referencevalue (0.46 mmol/day) at all time points in obese controls that developed stones (○ open circles, - · - · - · - dash-dot line). Panel B: At all time points CaOx SS was highest in the post bariatric surgery patients that developed stones (Δ open diamonds, —— solid line), but still at or above the reference mean (1.77 DG) in both obese controls with stones (○ open circles, - · - · - dash-dot line) as well as post bariatric surgery patients without stones (◆ solid diamonds, - - - - dashed line).
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Figure 3: Changes in urine oxalate and CaOx SS after surgeryPanel A: Urinaryoxalate increased subtly in all cases over time after bariatric surgery (◆ solid diamonds, - - - - dashed line), and more dramatically in those that developed stones (Δ open triangles, —— solid line). Mean urine oxalate was at the upper limit of the referencevalue (0.46 mmol/day) at all time points in obese controls that developed stones (○ open circles, - · - · - · - dash-dot line). Panel B: At all time points CaOx SS was highest in the post bariatric surgery patients that developed stones (Δ open diamonds, —— solid line), but still at or above the reference mean (1.77 DG) in both obese controls with stones (○ open circles, - · - · - dash-dot line) as well as post bariatric surgery patients without stones (◆ solid diamonds, - - - - dashed line).

Mentions: Urinary supersaturation profiles were available after bariatric surgery for 55 patients with follow-up stones and 248 without follow-up stones, as well as 20 obese controls with follow-up stones (Table 6). For the bariatric surgery group, data are presented broken down as < 8 mos after surgery (first follow-up visits) and > 8 mos after surgery (later visits). Urine oxalate excretion increased with time after surgery (< 8 mos verus > 8 mos P<0.001, and was most prominent in the post bariatric patients who developed stones > 8 months after surgery (0.70(0.37) (stone) vs 0.47(0.34) mmol/day (no stone); P<0.001). Urine citrate was also lower in this group (448 (340) (stone) vs 610(417) mg/day (no stone), P<0.001), resulting in higher overall CaOx supersaturations (2.12(0.92) (stone) vs 1.50(0.95) DG (no stone), P<0.001). Urine volumes were appreciable lower in the < 8 mos group regardless of stone status, resulting in higher supersaturations despite lower oxalate excretion at this time period. Increasing urine oxalate excretion was characteristic of the post bariatric stone forming group, with oxalate excretions appreciably higher than the non-stone forming post bariatric surgery patients and the obese stone formers (Figure 3a). Overall, CaOx SS tended to decrease in the non-stone forming post bariatric group, but remained high in those patients who experienced stone formation after surgery (Figure 3b).


Kidney stones are common after bariatric surgery.

Lieske JC, Mehta RA, Milliner DS, Rule AD, Bergstralh EJ, Sarr MG - Kidney Int. (2014)

Changes in urine oxalate and CaOx SS after surgeryPanel A: Urinaryoxalate increased subtly in all cases over time after bariatric surgery (◆ solid diamonds, - - - - dashed line), and more dramatically in those that developed stones (Δ open triangles, —— solid line). Mean urine oxalate was at the upper limit of the referencevalue (0.46 mmol/day) at all time points in obese controls that developed stones (○ open circles, - · - · - · - dash-dot line). Panel B: At all time points CaOx SS was highest in the post bariatric surgery patients that developed stones (Δ open diamonds, —— solid line), but still at or above the reference mean (1.77 DG) in both obese controls with stones (○ open circles, - · - · - dash-dot line) as well as post bariatric surgery patients without stones (◆ solid diamonds, - - - - dashed line).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4382441&req=5

Figure 3: Changes in urine oxalate and CaOx SS after surgeryPanel A: Urinaryoxalate increased subtly in all cases over time after bariatric surgery (◆ solid diamonds, - - - - dashed line), and more dramatically in those that developed stones (Δ open triangles, —— solid line). Mean urine oxalate was at the upper limit of the referencevalue (0.46 mmol/day) at all time points in obese controls that developed stones (○ open circles, - · - · - · - dash-dot line). Panel B: At all time points CaOx SS was highest in the post bariatric surgery patients that developed stones (Δ open diamonds, —— solid line), but still at or above the reference mean (1.77 DG) in both obese controls with stones (○ open circles, - · - · - dash-dot line) as well as post bariatric surgery patients without stones (◆ solid diamonds, - - - - dashed line).
Mentions: Urinary supersaturation profiles were available after bariatric surgery for 55 patients with follow-up stones and 248 without follow-up stones, as well as 20 obese controls with follow-up stones (Table 6). For the bariatric surgery group, data are presented broken down as < 8 mos after surgery (first follow-up visits) and > 8 mos after surgery (later visits). Urine oxalate excretion increased with time after surgery (< 8 mos verus > 8 mos P<0.001, and was most prominent in the post bariatric patients who developed stones > 8 months after surgery (0.70(0.37) (stone) vs 0.47(0.34) mmol/day (no stone); P<0.001). Urine citrate was also lower in this group (448 (340) (stone) vs 610(417) mg/day (no stone), P<0.001), resulting in higher overall CaOx supersaturations (2.12(0.92) (stone) vs 1.50(0.95) DG (no stone), P<0.001). Urine volumes were appreciable lower in the < 8 mos group regardless of stone status, resulting in higher supersaturations despite lower oxalate excretion at this time period. Increasing urine oxalate excretion was characteristic of the post bariatric stone forming group, with oxalate excretions appreciably higher than the non-stone forming post bariatric surgery patients and the obese stone formers (Figure 3a). Overall, CaOx SS tended to decrease in the non-stone forming post bariatric group, but remained high in those patients who experienced stone formation after surgery (Figure 3b).

Bottom Line: Obesity, a risk factor for kidney stones and chronic kidney disease (CKD), is effectively treated with bariatric surgery.The risk of CKD significantly increased after the malabsorptive procedures (adjusted hazard ratio of 1.96).Thus, while RYGB and malabsorptive procedures are more effective for weight loss, both are associated with increased risk of stones, while malabsorptive procedures also increase CKD risk.

View Article: PubMed Central - PubMed

Affiliation: 1] Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA [2] Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.

ABSTRACT
Obesity, a risk factor for kidney stones and chronic kidney disease (CKD), is effectively treated with bariatric surgery. However, it is unclear whether surgery alters stone or CKD risk. To determine this we studied 762 Olmsted County, Minnesota residents who underwent bariatric surgery and matched them with equally obese control individuals who did not undergo surgery. The majority of bariatric patients underwent standard Roux-en-Y gastric bypass (RYGB; 78%), with the remainder having more malabsorptive procedures (very long limb RYGB or biliopancreatic diversion/duodenal switch; 14%) or restrictive procedures (laparoscopic banding or sleeve gastrectomy; 7%). The mean age was 45 years with 80% being female. The mean preoperative body mass index (BMI) was 46.7 kg/m(2) for both cohorts. Rates of kidney stones were similar between surgery patients and controls at baseline, but new stone formation significantly increased in surgery patients (11.0%) compared with controls (4.3%) during 6.0 years of follow-up. After malabsorptive and standard surgery, the comorbidity-adjusted hazard ratio of incident stones was significantly increased to 4.15 and 2.13, respectively, but was not significantly changed for restrictive surgery. The risk of CKD significantly increased after the malabsorptive procedures (adjusted hazard ratio of 1.96). Thus, while RYGB and malabsorptive procedures are more effective for weight loss, both are associated with increased risk of stones, while malabsorptive procedures also increase CKD risk.

No MeSH data available.


Related in: MedlinePlus