Effect of Bariatric Surgery on Diagnosed Chronic Kidney Disease and Cardiovascular Events in Patients with Insulin-treated Type 2 Diabetes: a Retrospective Cohort Study from a Large UK Primary Care Database

AbstractAimsTo compare the effect of bariatric surgery on renal, chronic kidney disease (CKD) and cardiovascular (CV) outcomes among obese patients with insulin-treated type 2 diabetes (T2D) with and without microalbuminuria (i.e., uACR> 3.0 mg/mmol).MethodsA retrospective cohort study was conducted among 11,125 active patients with T2D from The Health Improvement Network (THIN) database. Propensity score matching (up to 1:6 ratio) was used to identify patients who underwent bariatric surgery (N = 131) with a non-bariatric cohort (N = 579). Follow-up was undertaken for 10 years (6487 person-years) to compare differences in risk of cardiovascular events and in renal outcomes.ResultsFor the matched cohort at baseline: mean age 52 ± 13 years (60% female); weight 116 ± 25 kg, body mass index (BMI) 41 ± 9kg/m2, estimated glomerular filtration rate (eGFR); 70.4 ± 20 mL/min/1.73 m2, and median albumin-creatinine ratio (uACR) 2.0 mg/mmol (interquartile range (IQR): 0.9 –5.2 mg/mmol). Bariatric surgery was associated with a 54% reduction in developing CKD compared to their matched non-bariatric cohort (adjusted hazard ratio [aHR]: 0.46; 95%CI: 0.24–0.85,P = 0.02). Among patients with microalbuminuria at baseline, bariatric surgery was protective against CKD (aHR: 0.42, 95%CI: 0.18 –0.99,P = 0.050). eGFR was significantly increased from baseline favouring the bariatric group during 75% of the follow-up time (calculated mean difference be...
Source: Obesity Surgery - Category: Surgery Source Type: research

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CONCLUSION: MS is beneficial where the main aim is to attain a significant and long-lasting weight loss results. The RCTs have depicted the superiority which surgical mechanisms hold over medically based therapy, for enhancing glycaemic control, and achieving remission of diabetes. This type of surgery improves life quality, reduces incidences of other obesity and diabetes relating diseases like microvascular illness, sleep apnea, fatal disorder, and fatty liver disease. PMID: 32077829 [PubMed - as supplied by publisher]
Source: Current Cardiology Reviews - Category: Cardiology Tags: Curr Cardiol Rev Source Type: research
AbstractBackgroundWhile evidence of improved renal function following gastric bypass exists, pre-operative predictors of this improvement are not completely known.ObjectivesTo assess the glomerular filtration rate (GFR) 1  year after Roux-en-Y gastric bypass (RYGB) and to identify pre-operative predictors associated with the improvement of renal function.MethodsA historical cohort study, which included 109 obese patients before and 12  months after RYGB, was classified into subgroups according to GFR (normofiltration, hypofiltration (GFR   95th percentile)). The 5th and 95th percentiles were 90 and ...
Source: Obesity Surgery - Category: Surgery Source Type: research
Purpose of review Through its direct adverse effects on the kidney and via associated intermediate disease states like type 2 diabetes and hypertension, obese has arguably become the master risk factor for chronic kidney disease (CKD). The purpose of this review is to critically evaluate bariatric surgery, which is the most effective weight reduction strategy available, as a renoprotective strategy. Recent findings Recent randomized studies confirm that bariatric surgery is effective at improving or even remitting major CKD risk factors such as type 2 diabetes and hypertension. In addition, observational studies perfo...
Source: Current Opinion in Nephrology and Hypertension - Category: Urology & Nephrology Tags: DIAGNOSTICS AND TECHNIQUES: Edited by Maarten W. Taal Source Type: research
Background: Type 2 Diabetes Mellitus (T2DM) is the main risk factor for Chronic Kidney Disease(CKD). With the increased prevalence of obesity in recent decades, the incidence of CKD has exponentially increased. Our goal in this study is to demonstrate how bariatric surgery affects glomerular filtration rate in T2DM patients and compare it with non-diabetic patients.
Source: Surgery for Obesity and Related Diseases - Category: Surgery Authors: Source Type: research
Authors: Martin WP, Docherty NG, Le Roux CW Abstract INTRODUCTION: Cardiovascular and renal disease accounts for a substantial proportion of the morbidity and mortality associated with obesity and type 2 diabetes mellitus (T2DM). Bariatric surgery is associated with improved long-term cardiovascular and renal outcomes. Areas covered: All major case-control, cohort, and randomized controlled trial studies of bariatric surgery in adults with T2DM were screened and data on prespecified cardiovascular and renal outcomes collated. Bariatric surgery reduces all-cause mortality and risk of cardiovascular disease, albuminu...
Source: Expert Review of Endocrinology and Metabolism - Category: Endocrinology Tags: Expert Rev Endocrinol Metab Source Type: research
Metabolic surgery offers the opportunity to durably address several obesity-related co-morbidities, many of which have complex interaction and deleterious end-organ effects [1]. The destructive potential of type 2 diabetes, for instance, on renal function in morbidly obese patients is well known and need not be summarized for this audience. Patients with impaired renal function are common in bariatric practices/programs and may present anywhere along the chronic kidney disease spectrum, even including dialysis-dependent patients seeking bariatric surgery as a potential bridge to renal transplant [2].
Source: Surgery for Obesity and Related Diseases - Category: Surgery Authors: Tags: Editorial comment Source Type: research
Abstract BACKGROUND: Diabetes mellitus is the most common cause of end-stage renal disease, which is associated with increased morbidity and mortality. The impact of bariatric surgery on chronic kidney disease is unclear. OBJECTIVES: Our primary aim was to assess the impact of bariatric surgery on estimated glomerular filtration rate (eGFR) in type 2 diabetes (T2D) patients. Our secondary aim was to compare the impact of bariatric surgery versus routine care on eGFR in patients with T2D. SETTING: University Hospital, United Kingdom. METHODS: A retrospective cohort analysis of adults with T2D who und...
Source: Surgery for Obesity and Related Diseases : official journal of the American Society for Bariatric Surgery - Category: Surgery Authors: Tags: Surg Obes Relat Dis Source Type: research
Diabetes mellitus (DM) is the most common cause of end-stage renal disease (ESRD). ESRD is associated with increased morbidity and mortality. The impact of bariatric surgery on chronic kidney disease (CKD) is unclear.
Source: Surgery for Obesity and Related Diseases - Category: Surgery Authors: Source Type: research
THE CHALLENGES OF PROVIDING SAFE AND EFFECTIVE pain management for patients with obesity are present throughout the perioperative setting. Obesity is associated with chronic medical comorbidities, such as coronary artery disease, stroke, chronic kidney disease, nonalcoholic fatty liver disease, and type 2 diabetes.1 Other obesity-associated comorbidities include breast, endometrial, ovarian, colorectal, esophageal, kidney, pancreatic, and prostate cancers, chronic back pain, and osteoarthritis.1 The demand for bariatric surgery has risen markedly in recent years with the total number of surgeries performed in the United St...
Source: Journal of PeriAnesthesia Nursing - Category: Nursing Authors: Tags: Pain Care Source Type: research
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