ODP002 ASSOCIATION BETWEEN OBESITY AND DIABETES POTENTIATES RENAL FUNCTION IMPAIRMENT IN BARIATRIC PATIENTS

Obesity may impair renal function directly or through comorbidities and complications, such as Diabetes Mellitus (DM), hypertension, and dyslipidemia.

To evaluate renal function in obese patients before treatment with bariatric surgery.

Serum creatinine was evaluated pre-operatively in 68 obese patients referred to treatment with sleeve gastroplasty. Glomerular filtration rate (eGFR) was estimated through the CKD-EPI Creatinine 2009 Equation. Data on prevalence and occasionally treatment of DM and hypertension were obtained and an additional biochemical work-up (hbA1c, lipid profile, vitamin D) was performed.

Fifty-one subjects had class III obesity (75%) and 17 were classified as class II with metabolic or locomotor complications (25%). Most patients were women (70.6%), had hypertension (66.2%) and low vitamin D (85.9%) and HDL (52.9%) levels. Mean age was 37.8± 8.6 years and mean BMI 43.43± 5.72 kg/m². The prevalence of DM was 47.6%. While 47.1% of the patients were using renin–angiotensin–aldosterone system inhibitors, only a few were using reno-protective antidiabetic drugs (4.4% on SGLT2 inhibitors and 1.5% on GLP1 agonists). Mean serum creatinine was 0.8± 0.2 mg/dL and eGFR, 100.9± 18. 0 mL/min/1.73m² (26.5% of patients had eGFR below 90 and 1.5%, values above 130 mL/min/1.73m²). Mean HbA1c was 5.9±0.8% (DM: 6.4±0.9%, non-diabetics: 5.4±0.2%, p < 0. 0001) and HbA1c was above 6.5% in 16.9% of the patients. Mean LDL, HDL, and triglycerides were, respectively, 121.2± 29.9, 47.1± 10.2, and 148.4± 64.6 mg/mL and mean 25OH vitamin D was 22.6± 8. 0 ng/mL. Creatinine levels of patients with class II and III obesity were similar (0.8± 0.1 vs. 0.8± 0.2 mg/dL, respectively, p = 0.3273) and there was no significant difference when eGFR of these two groups was compared (100.9± 15.5 vs. 100.9± 18.8 mL/min/1.73m², respectively, p = 1. 0000). Patients with DM had higher creatinine levels (0.9± 0.2 vs. 0.8± 0.1 mg/dL, p = 0. 0154) and lower eGFR (96.3 ± 18.3 vs. 105. 0 ± 16.9mL/min/1.73m², p = 0. 0439) than non-diabetics. Linear regression models indicated statistically significant associations between creatinine and eGFR and the presence of DM (p = 0. 0154 and 0. 0439, respectively). No association involving creatinine or eGFR and presence of hypertension, or levels of BMI, LDL, HDL, triglycerides, vitamin D or HbA1c was detected.

The study points to the importance of pre-operative renal function screening in bariatric patients, since more than a quarter of the subjects had a decrease in glomerular filtration before surgery at a relatively young age. Although no association between long-term glucose control, represented by HbA1c, and renal function was detected, obese patients with DM seem to be at higher risk for precocious renal function impairment.

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