State-of-the-art Medical Therapy Versus Roux-en-Y Gastric Bypass Alone for Treatment of Early Diabetic Kidney Disease.

Autor:	Friedman AN; Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN., Petry TBZ; The Center for Obesity and Diabetes, Oswaldo Cruz German Hospital, São Paulo, Brazil., Aboud CM; The Center for Obesity and Diabetes, Oswaldo Cruz German Hospital, São Paulo, Brazil., Mendonca Dos Santos T; Insper Institute of Education and Research, Sao Paulo, Brazil., Roux CWL; Diabetes Complications Research Center, UCD Conway Institute, University College Dublin School of Medicine, Dublin, Ireland; Investigative Medicine, Imperial College London, London, United Kingdom., Cohen RV; The Center for Obesity and Diabetes, Oswaldo Cruz German Hospital, São Paulo, Brazil. Electronic address: ricardo.cohen@haoc.com.br.
Jazyk:	angličtina
Zdroj:	Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation [J Ren Nutr] 2022 Nov; Vol. 32 (6), pp. 768-771. Date of Electronic Publication: 2022 Mar 31.
DOI:	10.1053/j.jrn.2022.03.003
Abstrakt:	Objective: Type 2 diabetic kidney disease (DKD) is the most common global cause of kidney disease and failure. Obesity is a major risk factor for DKD due to its causal relationship with diabetes, hypertension, and other factors promoting kidney disease. We therefore investigated whether metabolic surgery such as Roux-en-Y gastric bypass is more effective than state-of-the-art medical therapy (i.e., renin-angiotensin-aldosterone system, sodium-glucose co-transporter 2 inhibitors, and glucagon-like peptide-1 receptor agonists) in treating DKD. Design and Methods: In a post hoc analysis of the Microvascular Outcomes after Metabolic Surgery trial, we compared the likelihood of regression of microalbuminuria as the primary endpoint and other renal and metabolic secondary endpoints in a population of patients with obesity, type 2 diabetes, microalbuminuria, and early chronic kidney disease followed for 24 months. Nine patients underwent Roux-en-Y gastric bypass, and 24 patients were on state-of-the-art medical therapy. Results: The gastric bypass arm had a significantly higher rate of regression of microalbuminuria (P < .001), borderline significant reduction in mean urine albumin-to-creatinine ratio (P = .055), and much greater weight loss (P = .001). There were no statistically significant differences between arms in estimated glomerular filtration rate, risk of developing estimated glomerular filtration rate <60 mL/min/1.73 m 2 over 5 years, mean hemoglobin A1c, systolic blood pressure, low-density lipoprotein cholesterol, or the American Diabetes Association triple endpoint. Conclusion: We found that metabolic surgery offers more kidney protection than state-of-the-art triple therapy for DKD at 24 months. Prospective studies in this area are necessary to better define the benefits and risks of medical versus surgical treatment of DKD. (Copyright © 2022 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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