You are leaving Medscape Education
Cancel Continue
Log in to save activities Your saved activities will show here so that you can easily access them whenever you're ready. Log in here CME & Education Log in to keep track of your credits.
 

CME

Gastric Bypass Can Improve Renal Function in Patients With Morbid Obesity

  • Authors: News Author: Jacquelyn K. Beals, PhD
    CME Author: Laurie Barclay, MD
  • CME Released: 6/23/2008
  • THIS ACTIVITY HAS EXPIRED
  • Valid for credit through: 6/23/2009
Start Activity


Target Audience and Goal Statement

This article is intended for clinicians who want to maintain a current understanding of recent research and evidence regarding chronic renal disease and morbid obesity in patients who have undergone gastric bypass surgery.

The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.

Upon completion of this activity, participants will be able to:

  1. Inform clinicians of the latest medical information about chronic renal disease as an indication, not a contraindication, for gastric bypass surgery in obese patients, as presented at the American Society for Metabolic & Bariatric Surgery 25th Annual Meeting.
  2. Describe the relevance of the findings that patients with morbid obesity who also have chronic renal disease may improve or have stabilized renal function after gastric bypass to clinicians in the care of their morbidly obese patients.


Disclosures

As an organization accredited by the ACCME, Medscape, LLC requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.


Author(s)

  • Jacquelyn K. Beals, PhD

    Jacquelyn K. Beals, PhD, is a freelance writer for Medscape.

    Disclosures

    Disclosure: Jacquelyn K. Beals, PhD, has disclosed no relevant financial relationships.

Editor(s)

  • Brande Nicole Martin

    Brande Nicole Martin is the News CME editor for Medscape Medical News.

    Disclosures

    Disclosure: Brande Nicole Martin has disclosed no relevant financial information.

CME Author(s)

  • Laurie Barclay, MD

    Laurie Barclay, MD is a freelance reviewer and writer for Medscape.

    Disclosures

    Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.


Accreditation Statements

    For Physicians

  • Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

    Medscape, LLC designates this educational activity for a maximum of 0.25 AMA PRA Category 1 Credit(s)™ . Physicians should only claim credit commensurate with the extent of their participation in the activity. Medscape Medical News has been reviewed and is acceptable for up to 300 Prescribed credits by the American Academy of Family Physicians. AAFP accreditation begins 09/01/07. Term of approval is for 1 year from this date. This activity is approved for 0.25 Prescribed credits. Credit may be claimed for 1 year from the date of this activity. AAFP credit is subject to change based on topic selection throughout the accreditation year.


    AAFP Accreditation Questions

    Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]


Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page.

Follow these steps to earn CME/CE credit*:

  1. Read the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or printed out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. Medscape encourages you to complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 5 years; at any point within this time period you can print out the tally as well as the certificates by accessing "Edit Your Profile" at the top of your Medscape homepage.

*The credit that you receive is based on your user profile.

CME

Gastric Bypass Can Improve Renal Function in Patients With Morbid Obesity

Authors: News Author: Jacquelyn K. Beals, PhD CME Author: Laurie Barclay, MDFaculty and Disclosures
THIS ACTIVITY HAS EXPIRED

CME Released: 6/23/2008

Valid for credit through: 6/23/2009

processing....

From American Society for Metabolic & Bariatric Surgery (ASMBS) 25th Annual Meeting

June 23, 2008 (Washington, DC) — Patients with morbid obesity who also have chronic renal disease (CRD) may improve or stabilize renal function after gastric bypass, according to a study presented here at the American Society for Metabolic & Bariatric Surgery 25th Annual Meeting.

CRD is common in obese patients, and chronic renal failure is more than 7 times higher in patients with body mass index (BMI) of 40 kg/m2 or higher. However, many centers for bariatric surgery will not perform gastric bypass in CRD patients, particularly those receiving dialysis or awaiting kidney transplant.

J. Wesley Alexander, MD, ScD, Center for Surgical Weight Loss, University of Cincinnati College of Medicine, Department of Surgery, and The Christ Hospital, Cincinnati, Ohio, presented the study of CRD patients who had gastric bypass surgery. Of these patients, 10 had gastric bypass after receiving a kidney transplant, 14 had a kidney transplantation later, 17 were receiving dialysis, 8 had "miscellaneous problems with renal disease."

Of the 9 patients who experienced stabilization or improvement of their CRD, 2 were receiving dialysis, and 7 were anticipating a kidney transplant. Two of the 9 patients had been diagnosed with membranous glomerulonephritis, 5 with focal segmental glomerulosclerosis (FSGS), and 2 with diabetes. Their average age at the time of gastric bypass surgery was 43 years. Mean BMI was 48.9 ± 1.9 kg/m2. The surgeries were not complicated by 30-day mortalities, primary deep wound infections, or transfusions.

Medscape General Surgery talked with Dr. Alexander about the association between obesity and renal disease. "Renal function is sometimes altered by inflammatory processes, and obesity is associated with sort of a baseline inflammation, with increased levels of IL-6 and TNF [tumor necrosis factor]. ... Those are inflammatory markers, and they get better after a gastric bypass," said Dr. Alexander.

However, he thinks inflammatory processes are a minor part of the picture: "Diabetes is a major part of it because obese patients have a much greater incidence of diabetes than the general population," said Dr. Alexander. "I would say maybe 4 or 5 times as much. In the general population [the occurrence of] diabetes is about 7.9%."

In the present study, 1 case of membranous glomerulonephritis resolved completely after a gastric bypass 8 years ago. Both patients receiving dialysis were able to stop dialysis (for 7 and 27 months, respectively). Renal function of the other patients has been stable for 2 to 5 years since gastric bypass.

The improvement in renal function after gastric bypass surgery can be rapid. "You have major improvement early with a gastric bypass within the first week. About half the patients lose their diabetes within the first week. ... It's before weight loss. It's related to hormones in the intestine and in the stomach. It's also related to some hormones in the lower part of the body called incretins. GLP-1 is one of those," explained Dr. Alexander.

Dr. Alexander also mentioned the role of hypertension in renal disease: "Hypertension is a very important potential factor. It's difficult to separate out the roles of these [ie, hypertension and diabetes] in morbid obesity at least. Morbid obese patients have diabetes and have hypertension at a greater rate," he said. "Diabetes is improved, almost always, after gastric bypass. Hypertension is not improved as much as diabetes is, because there are underlying factors, like genetic factors, which play a major role."

The proteinuria and CRD associated with obesity reflect hyperfiltration and increased venous pressure, as well as obesity-related FSGS. Medscape General Surgery discussed the issue of protein intake after gastric bypass surgery with John Dixon, MD, a comoderator of the session, from the Centre for Obesity Research and Education, Monash University, Melbourne, Australia.

"A truly high-protein diet is not necessary after gastric bypass surgery. It needs to be an adequate protein diet, and adequate for that person. Therefore, it's only a theoretical problem that there could be an issue with renal disease," said Dr. Dixon. "Clearly a truly high-protein diet ... can exacerbate uremia in renal disease. So we're not concerned that protein is an issue, and it can be adjusted for within that patient's treatment."

Dr. Dixon noted that the type of patients in this study are not as common as the study suggests. "They were covering an unusual group ... to get together a really significant number of patients with quite impaired renal function — which is unusual. And therefore, they were able to observe some improvement in some of these and not others." The study showed that patients with FSGS improved with weight loss. "In particular, this is the type of glomerular disease, or kidney disease that is associated with obesity, one we would expect might improve with weight-loss," observed Dr. Dixon.

The authors of the study concluded that, because gastric bypass surgery can improve or stabilize CRD, clinicians should regard CRD as an indication, rather than a contraindication, for gastric bypass surgery in patients with morbid obesity and CRD.

Dr. Alexander has disclosed no relevant financial relationships. Dr. Dixon has disclosed receiving consulting fees from Inamed/Allergan and has ownership interest in Bariatric Advantage.

American Society for Metabolic & Bariatric Surgery 25th Annual Meeting: Abstract PL-26. Presented June 19, 2008.

Pearls for Practice

  • The association between obesity and renal disease is largely mediated by diabetes, which is likely to improve after gastric bypass surgery. Because gastric bypass surgery can also improve or stabilize CRD, clinicians should regard CRD as an indication, rather than a contraindication, for gastric bypass surgery in patients with morbid obesity and CRD.
  • Of 49 patients with CRD who underwent gastric bypass surgery, 9 had improvement or stabilization of CRD. Among these 9 patients, 1 of 2 with membranous glomerulonephritis had complete resolution; both patients receiving dialysis were able to stop dialysis; and renal function of the other patients remained stable for 2 to 5 years since their gastric bypass surgery. The surgeries were not complicated by 30-day mortalities, primary deep wound infections, or transfusions.

CME Test

  • Print