Chronic kidney disease and metabolic surgery in Asia

Jun Liang Teh, Asim Shabbir

Abstract

The incidence of metabolic disease is steadily rising in Asia. Obese patients with and without metabolic disease are both at risk of chronic kidney impairment and subsequent renal failure, a disease with significant mortality and morbidity. With metabolic surgery proven to be effective for diabetes remission, there has been recent interest in the efficacy of metabolic surgery for prevention or thwarting renal disease progression in obese patients. Metabolic surgery with its resultant malabsorption syndromes, may in fact put one at higher risk of acute renal impairment post operatively due to nephrolithiasis. We examine the recent evidence in the medical literature for the benefits and risks of bariatric surgery in patients with renal impairment. Recent evidence both from Asian and Western patients suggest that glomerular filtration capability and proteinuria improve post bariatric surgery, especially in patients undergoing Roux-en-Y gastric bypass. There is still a lack of literature pertaining to the efficacy of metabolic surgery in the improvement of renal function in Asian patients subgroups especially in those who undergo other procedures apart from RYGB and those who undergo bariatric surgery prior to or after renal transplant.