ABSTRACT Bariatric surgery is an effective therapy for obesity, hypertension and type 2 diabetes mellitus that is refractory to maximal medical therapy. Results of long-term cohort studies

and emerging evidence from randomized clinical trials have revealed that, in addition to its beneficial effects on weight reduction, blood pressure and metabolic control, bariatric surgery

might reduce the incidence and long-term progression of chronic kidney disease (CKD). Preclinical studies have provided experimental verification that bariatric surgery improves key

parameters of kidney injury at the functional, structural and ultrastructural levels, and effects a programme of transcriptomic change in the kidney that is coherent with injury resolution.

consideration of how to identify and mitigate some of the challenges associated with these surgical procedures. KEY POINTS * A causal link between elevated BMI and the incidence and

progression of chronic kidney disease (CKD) is now well substantiated. * Bariatric surgery reduces risk factors implicated in the progression of kidney injury in obesity and type 2 diabetes

mellitus. * Long-term outcomes of bariatric surgery confirm the role of obesity as a modifiable risk factor for advanced CKD. * Preclinical studies demonstrate that bariatric surgery

improves biochemical, structural and ultrastructural measures of experimental diabetic kidney disease and interrupts the transcriptional programme characteristic of progressive CKD. *

Definitive randomized clinical trial studies comparing kidney outcomes and safety following best medical therapy alone or best medical therapy in combination with bariatric surgery at

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Contact customer support SIMILAR CONTENT BEING VIEWED BY OTHERS REMISSION AND PROGRESSION OF PRE-EXISTING MICRO- AND MACROALBUMINURIA OVER 15 YEARS AFTER BARIATRIC SURGERY IN SWEDISH OBESE

SUBJECTS STUDY Article 07 November 2020 OBESITY AND THE KIDNEY: MECHANISTIC LINKS AND THERAPEUTIC ADVANCES Article 13 February 2024 SLEEVE GASTRECTOMY AMELIORATES RENAL INJURY IN

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ACKNOWLEDGEMENTS N.G.D. is also a visiting researcher at the Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden. C.W.l.R. also holds an adjunct Professor

position in Investigative Science at Imperial College London, UK. The authors acknowledge funding support from the following agencies: Swedish Medical Research Council (2015-02733) and

European Foundation for the Study of Diabetes/Boehringer Ingelheim European Diabetes Research Programme (BI 2017_3) to C.W.l.R. and N.G.D., and Science Foundation Ireland (12/YI/B2480) to

C.W.l.R. AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College, Dublin, Ireland

Neil G. Docherty & Carel W. le Roux Authors * Neil G. Docherty View author publications You can also search for this author inPubMed Google Scholar * Carel W. le Roux View author

publications You can also search for this author inPubMed Google Scholar CONTRIBUTIONS Both authors researched data for the article, wrote the manuscript, made substantial contributions to

discussions of the content, and reviewed or edited the manuscript before submission. CORRESPONDING AUTHOR Correspondence to Neil G. Docherty. ETHICS DECLARATIONS COMPETING INTERESTS C.W.l.R.

is an advisory board member for Novo Nordisk, Herbalife, Johnson & Johnson, Keyron and GI Dynamics, and has received honoraria for speaking from Novo Nordisk, Herbalife, Johnson &

Johnson, GI Dynamics, Lilly, MSD and Consilient Health. N.G.D. declares no competing interests. ADDITIONAL INFORMATION PEER REVIEW INFORMATION _Nature Reviews Nephrology_ thanks A.

Courcoulas, T. Diwan, R. Roussel and the other, anonymous, reviewer(s) for their contribution to the peer review of this work. PUBLISHER’S NOTE Springer Nature remains neutral with regard to

jurisdictional claims in published maps and institutional affiliations. GLOSSARY * Critical adipose threshold A concept that postulates that adipose storage capacity varies among

individuals owing to a threshold or upper limit in the triglyceride storage capacity of individual adipocytes. RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS

ARTICLE Docherty, N.G., le Roux, C.W. Bariatric surgery for the treatment of chronic kidney disease in obesity and type 2 diabetes mellitus. _Nat Rev Nephrol_ 16, 709–720 (2020).

https://doi.org/10.1038/s41581-020-0323-4 Download citation * Accepted: 30 June 2020 * Published: 10 August 2020 * Issue Date: December 2020 * DOI: https://doi.org/10.1038/s41581-020-0323-4

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