Gastric bypass may increase odds of CKD remission in patients with diabetes, obesity
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For patients with type 2 diabetes and obesity, undergoing Roux-en-Y gastric bypass surgery led to greater remission rates of albuminuria and early stage chronic kidney disease compared with best medical care.
These findings indicate the procedure should be considered as a means to slow or halt CKD progression in this patient population, according to Ricardo Vitor Cohen, MD, of the Center for Obesity and Diabetes, Oswaldo Cruz German Hospital in Brazil, and colleagues.
“Observational studies showing that metabolic surgery is associated with reduced albuminuria and long-term incidence of [end-stage kidney disease] ESKD support the premise that significant weight loss can play a critical role in effecting long-term reductions in kidney disease risk in patients with obesity and type 2 diabetes,” the researchers wrote. “ ... This trial was designed to test the hypothesis that [Roux-en-Y gastric bypass] RYGB would be more effective than best medical treatment as a means of achieving remission of microalbuminuria in patients with type 2 diabetes, obesity and early stage CKD at baseline, a cohort that has substantial residual risk of early morbidity and mortality.”
For the Microvascular Outcomes after Metabolic Surgery trial, 100 patients with a urinary albumin-creatinine ratio (uACR) greater than 30 mg and eGFR of greater than 30 mL/min/m2 were randomized to receive best medical care (based on the 2019 American Diabetes Association and European Association for Study of Diabetes guidelines) or gastric bypass surgery. The researchers noted both groups had similar demographic and clinical characteristics, with a mean age of 51.4 years.
After 24 months, 55% of patients receiving best medical treatment achieved remission of albuminuria compared with 82% of those who underwent RYGB. This resulted in CKD remission rates of 48% for those receiving best medical treatment and 82% for those who underwent the surgery.
Further findings showed the geometric mean uACRs were 55% lower after RYGB (10.7 mg/g of creatinine) than after best medical treatment (23.6 mg/g of creatinine).
The researchers also observed the safety profile of RYGB was comparable to that of best medical care, with no deaths, episodes of serious hypoglycemia, malnutrition or excessive weight loss occurring in either group.
“The data presented herein confirm observational data that RYGB is significantly associated with reduced urinary albumin excretion in patients with type 2 diabetes and furthermore demonstrate that the judicious use of RYGB with state-of-the-art medication enhances remission of albuminuria and stage G1 to G3 and A2 to A3 CKD,” Cohen and colleagues concluded of the findings.
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