Diabetes remission following bariatric surgery translates to CKD risk improvements
Remission of type 2 diabetes (T2D) after bariatric surgery confers benefits for albuminuria and stabilizes prognostic risk for chronic kidney disease (CKD) but yields negligible improvements in estimated glomerular filtration rate (eGFR), according to a study.
Moreover, patients with reduced kidney function and greater prognostic risk prior to undergoing the weight-loss surgery appear to have lower the odds of achieving T2D remission.
The prospective observational study followed 737 bariatric surgery patients with T2D (median age, 52 years; 70.6 female) for up to 5 years, with researchers obtaining data on demographics, blood pressure, medications, type of weight-loss surgery, anthropometrics, markers of kidney disease, and circulating levels of gut hormones and peptides.
In the cohort, median HbA1c level was 6.9 percent, while the median eGFR was 94 mL/min/1.73 m2, with 12 percent of patients having eGFR <60 mL/min/1.73 m2. Median UACR was 8.9 mg/g, with 22 percent of patients having moderately/severely increased albuminuria. In terms of prognosis, 18.8 percent, 8 percent and 3.3 percent of patients were in the moderately increased, high and very high KDIGO CKD risk categories, respectively.
T2D remission at 5 years postsurgery showed no significant relationship with eGFR but was associated with lower risk of moderate/severe increase in albuminuria (risk ratio, 0.66, 95 percent CI, 0.48–0.90) and stabilization (ie, no improvement or worsening) of prognostic risk for CKD. These associations were modified by baseline ghrelin level.
Furthermore, lower preoperative eGFR and greater prognostic risk for CKD were independently associated with reduced chances of diabetes remission, with C-peptide level modifying the association for preoperative GFR. Higher baseline circulating ghrelin level was associated with a lower prognostic risk for CKD.
Additional studies are needed to identify the mechanisms through which bariatric surgery may delay the long-term progression of CKD in T2D, the researchers said.