Risk of nephrolithiasis, hyperoxaluria, and calcium oxalate supersaturation increased after Roux-en-Y gastric bypass surgery: a systematic review and meta-analysis

Background: Earlier publications have shown renal stone complications after bariatric surgery. Multiple reports have also linked metabolic changes that alter the urinary chemistry profiles, especially hyperoxaluria, after bariatric surgery. However, evidence on change of other urine chemistry studies and type of bariatric surgery and risk of stone has been inconclusive so far.

Objectives: To explore the association between bariatric surgery and postoperative urinary chemistry change and risk of stone formation SETTING: A systematic review and meta-analysis.

Methods: We comprehensively searched the databases of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) from their dates of inception to January 2016. The inclusion criteria were published studies of association between bariatric surgery and postoperative renal stone formation or urine chemistry profiles. We used random-effects model meta-analysis and calculated the pooled risk of renal stone and difference in 24-hour urine chemistry profiles.

Results: Twelve observational studies were included in the meta-analysis. There was significantly higher risk of stone formation after Roux-en-Y gastric bypass surgery with pooled relative risk = 1.79 (95% CI: 1.54-2.10). In the analysis of urine chemistry profiles, there was significantly higher calcium oxalate supersaturation, lower citrate, and lower volume postoperatively compared with preoperatively. There was also higher urine oxalate in patients who had bariatric surgery compared with nonsurgery controls.

Conclusions: Roux-en-Y gastric bypass surgery is associated with higher risk of renal stone and increased urine oxalate and calcium oxalate supersaturation.