Diabetes: Bariatric surgery bests medical treatment in improving kidney disease
Delhi: Gastric bypass is more effective than the best medical treatment (BMT) in improving kidney disease in people with obesity and type 2 diabetes (T2D), a recent study in the journal JAMA Surgery. It found roux-en-Y gastric bypass (RYGB) to be a safe and more effective means of achieving remission of early-stage CKD and albuminuria than BMT treatment in patients with type 2 diabetes, obesity, and microalbuminuria.
The study is significant as in T2D patients early-stage chronic kidney disease (CKD) characterized by microalbuminuria is associated with future cardiovascular events, progression toward end-stage renal disease, and early mortality.
Ricardo Vitor Cohen, The Center for Obesity and Diabetes, Oswaldo Cruz German Hospital, São Paulo, Brazil, and colleagues conducted the study to compare the albuminuria-lowering effects of Roux-en-Y gastric bypass (RYGB) surgery vs best medical treatment in patients with early-stage CKD, type 2 diabetes, and obesity.
The researchers conducted a randomized, single-center trial of 100 patients with T2D, obesity, and microalbuminuria (urinary albumin-creatinine ratio [uACR] >30 mg/g and estimated glomerular filtration rate >30 mL/minute/1.73 m2). They were randomly assigned to BMT or RYGB (51 to RYGB and 49 to best medical care).
Key findings of the study include:
- Remission of albuminuria occurred in 55% of patients after best medical treatment and 82% of patients after RYGB, resulting in CKD remission rates of 48% after best medical treatment and 82% after RYGB.
- 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).
- No difference in the rate of serious adverse events was observed.
"After 24 months, RYGB was more effective than best medical treatment for achieving remission of albuminuria and stage G1 to G3 and A2 to A3 CKD in patients with type 2 diabetes and obesity," concluded the authors.
The study, "Effect of Gastric Bypass vs Best Medical Treatment on Early-Stage Chronic Kidney Disease in Patients With Type 2 Diabetes and Obesity: A Randomized Clinical Trial," is published in the journal JAMA Surgery.
DOI: 10.1001/jamasurg.2020.0420
