| アブストラクト | AIMS: To 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). METHODS: A 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. RESULTS: For the matched cohort at baseline: mean age 52 +/- 13 years (60% female); weight 116 +/- 25 kg, body mass index (BMI) 41 +/- 9kg/m(2), estimated glomerular filtration rate (eGFR); 70.4 +/- 20 mL/min/1.73 m(2), 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 between groups: 4.1 mL/min/1.73 m(2); P < 0.05), especially at 5-year point (74.2 vs 67.8 mL/min/1.73 m(2); P < 0.001). However, no significant change was observed with non-fatal CVD episodes (aHR: 0.36, 95%CI: 0.11-1.13, P = 0.079). Albumin levels were significantly reduced throughout the 2 years following the surgery (3.9 vs 4.1 g/dL, P < 0.001). uACR and total protein levels had little or no statistical association to the intervention. CONCLUSION: Bariatric surgery may protect patients with diabetes with or without microalbuminuria against the risk of CKD and with a modest protective effect on non-fatal CVD risk. Bariatric surgery is also associated with improvements in overall renal outcomes such as eGFR. |
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| ジャーナル名 | Obesity surgery |
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| 投稿日 | 2020/3/5 |
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| 投稿者 | Alkharaiji, Mohammed; Anyanwagu, Uchenna; Donnelly, Richard; Idris, Iskandar |
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| 組織名 | Division of Medical Sciences & Graduate Entry Medicine, School of Medicine, Royal;Derby Hospital, University of Nottingham, Derby, UK.;Faculty of Public Health, College of Health, The Saudi Electronic University,;Riyadh, Saudi Arabia.;Iskandar.idris@nottingham.ac.uk. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/32130651/ |
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