METABOLIC bariatric surgery offers substantial protective benefits for patients with chronic kidney disease (CKD), Type 2 diabetes, and obesity, according to new research.
Conducted at a large USA health system between 2010–2017, the study compared the effects of metabolic surgery with glucagon-like peptide-1 receptor agonists (GLP-1RA), a non-surgical therapy, in slowing CKD progression. “The fact is that nobody likes surgery, so if there’s a less invasive option available, people will tend to prefer it,” said lead author Ali Aminian, Bariatric and Metabolic Institute at Cleveland Clinic, Ohio, USA. “But surgery can save lives, improve health, and improve better quality of life.”
The research focused on 425 patients, with 183 undergoing metabolic bariatric surgery and 242 receiving continuous GLP-1RA treatment. All patients had diabetes, a BMI of ≥30 kg/m², an estimated glomerular filtration rate (eGFR) between 20–60 mL/min/1.73 m², and Stage 3 or 4 CKD. The median follow-up period was 5.8 years. The primary goal of the study was to measure the progression of CKD, defined as a decline in kidney function of ≥50%, the initiation of dialysis, or the need for a kidney transplant.
The results showed that patients in the surgery group had a cumulative CKD progression rate of 21.7% after 8 years, compared to 45.1% in the GLP-1RA group. This translated to a 60% lower risk of CKD progression for the surgical group (95% CI: 0.21–0.76; P=0.006). The study also looked at secondary outcomes, including the development of kidney failure or death. The surgical group exhibited a 44% lower risk of these severe outcomes compared to the non-surgical group (95% CI: 0.31–0.99; P=0.048).
The findings suggest that metabolic surgery offers a significant renoprotective effect, making it a viable therapeutic option for patients with Type 2 diabetes, CKD, and obesity. Researchers emphasise the need for healthcare providers to consider surgery as part of a comprehensive treatment plan for such patients.
Ada Enesco, EMJ
Reference
Aminian A et al. Renoprotective effects of metabolic surgery versus glp1 receptor agonists on progression of kidney impairment in patients with established kidney disease. Ann Surg.2024;DOI:10.1097/SLA.0000000000006379.
