Gastric bypass surgery slows kidney disease in patients with T2D and obesity

  • Cohen RV & al.
  • JAMA Surg
  • 3 Jun 2020

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • After 24 months, Roux-en-Y gastric bypass (RYGB) was more effective than best medical treatment (BMT) for achieving remission of albuminuria and chronic kidney disease (CKD) in patients with type 2 diabetes (T2D) and obesity.

Why this matters

  • CKD contributes to early mortality in patients with T2D.

Study design

  • 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) randomly assigned to BMT or RYGB.
  • Funding: Johnson & Johnson Brasil; Oswaldo Cruz German Hospital; Science Foundation Ireland; Swedish Medical Research Council.

Key results

  • After 24 months, albuminuria remission (uACR
  • 55% of patients (95% CI, 39.0%-70.0%) after BMT vs 
  • 82% (95% CI, 72%-93%) after RYGB (P=.006).
  • Geometric mean uACR:
    • 23.6 in BMT vs 
    • 10.7 mg/g in RYGB (P<.001>
  • Remission of early-stage CKD occurred in:
    • 48.2% (95% CI, 32.2%-64.1%) with BMT vs 
    • 81.9% (95% CI, 71.8%-92.1%) with RYGB (P=.002).
  • HbA1c was reduced by 2.2% in BMT vs 2.6% in RYGB (P=.048).
  • Proportions achieving T2D remission (HbA1c ≤6.0% [
  • 24.4% BMT vs 
  • 44.5% RYGB (P=.051).
  • Serious adverse events occurred in 13% of each group (P>.99).
  • Limitations

    • Open-label.
    • Short follow-up.
    • Primary outcome based on single first-morning urine.
    • Adverse events were heterogeneous.
    • Results are expertise-dependent.