bariatric surgery

Bariatric Surgery: How Effective Is it for Treating Chronic Kidney Disease?

Gastric bypass surgery was associated with significantly more patients achieving remission from end-stage chronic kidney disease (CKD) compared with pharmacotherapy, according to a recent study.1

“Contemporary advances in pharmacotherapy of type 2 diabetes show great promise in treating CKD. However, for many patients, CKD remains a chronic progressive disease despite best medical care,” the researchers wrote.

“This trial was designed to test the hypothesis that Roux-en-Y gastric bypass surgery (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.”

A total of 100 patients participated in the Microvascular Outcomes after Metabolic Surgery trial. All participants had type 2 diabetes, obesity, and stage G1 to G3 and A2 to A3 CKD, defined as urinary albumin-creatinine ratio [uACR] >30 mg/g and estimated glomerular filtration rate >30 mL/min. The patients were randomized to receive either medical treatment or RYGB.

Overall, remission of albuminuria was observed in 55% of patients in the medical treatment group and 82% of patients in the RYGB group. CKD remission occurred in 48% of those in the medical treatment group and in 82% of those in the RYGB group. RYGB was associated with mean uACRs that were 55% lower than those seen in patients in the medical treatment group.

“These findings point to a new treatment paradigm to reverse or prevent early chronic kidney disease progression in patients with diabetes and obesity,” said lead study author Ricardo Cohen, MD, in an accompanying press release. “Both patients, and the physicians who treat them for these diseases, should consider metabolic surgery together with medical management as a potentially better option than medical management alone.”2

—Michael Potts

References:

  1. Cohen RV, Pereira TV, Aboud CM, et al. Effect of gastric bypass vs best medical treatment on early-stage chronic kidney disease in patients with type 2 diabetes and obesity. Published online June 3, 2020. JAMA Surgery. doi:10.1001/jamasurg.2020.0420
  2. Bariatric surgery superior to best medical treatment for early chronic kidney disease in patients with obesity and type 2 diabetes. News release. Cincinnati, Ohio; Ethicon: July 13, 2020. https://www.jnjmedicaldevices.com/en-US/news-events/bariatric-surgery-superior-best-medical-treatment-early-chronic-kidney-disease-patients