For patients with type 2 diabetes, obesity and chronic kidney disease, bariatric surgery was associated with a significant decrease in the progression of chronic kidney disease compared to those who received GLP-1 diabetes medications, according to a paper presented at the 144th Annual Meeting American Surgical Association (ASA) and published in the Annals of Surgery by researchers from the Cleveland Clinic.
“Our study shows that bariatric surgery can protect the kidneys and prevent the worsening of kidney function,” said Dr Ali Aminian, lead author of the study and director of Cleveland Clinic’s Bariatric & Metabolic Institute. “In patients with obesity and type 2 diabetes who already have established chronic kidney disease, bariatric surgery can change the trajectory of the disease.”
The study included 425 adult patients (ages 18 to 75) with type 2 diabetes, obesity and stage 3 or 4 chronic kidney disease. Among the study participants, 183 patients underwent bariatric surgery while 242 patients were treated with GLP-1 receptor agonist medications.
Patients involved in the study underwent bariatric surgery between 2010 and 2017 or continuously received GLP-1 medications that were FDA-approved and available during the timeframe of the study. In the nonsurgical group, the most common GLP-1 medications were liraglutide and exenatide. During follow-up, 20% of patients in the nonsurgical group received newer GLP-1 medications such as semaglutide (Ozempic) or tirzepatide (Mounjaro) at some point.
Researchers found that bariatric surgery could protect kidney function and reduce the risk of kidney failure or death in patients. Specifically, study findings showed that bariatric surgery was associated with a 60% lower risk of progression of kidney disease and a 44% lower risk of developing kidney failure or death in comparison to the nonsurgical group.
Over the length of the eight-year study, researchers also found that 22% of the participants in the surgical group experienced progression of kidney disease compared to 45% in the non-surgical group. In addition, 24% in the surgical group developed kidney failure or died over the seven-year span of the study, compared to 44% in the non-surgical group.
The study participants who underwent bariatric surgery experienced more weight loss and better control of their diabetes. They also required less medication to control their diabetes, high blood pressure and high cholesterol.
“Despite its kidney-protective benefits, bariatric surgery is underutilised in clinical practice,” added Aminian. “In the current management guidelines of chronic kidney disease, while maintaining a healthy weight through lifestyle changes is advised, the option of bariatric surgery has not been considered.”
The findings were also reported in the paper, ‘Renoprotective Effects of Metabolic Surgery Versus GLP1 Receptor Agonists on Progression of Kidney Impairment in Patients with Established Kidney Disease’, published in the Annals of Surgery.
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