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.
Obes Surg. 2020 May;30(5):1685-1695. doi: 10.1007/s11695-019-04201-y.
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).
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.
For the matched cohort at baseline: mean age 52 ± 13 years (60% female); weight 116 ± 25 kg, body mass index (BMI) 41 ± 9kg/m, estimated glomerular filtration rate (eGFR); 70.4 ± 20 mL/min/1.73 m, 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; P < 0.05), especially at 5-year point (74.2 vs 67.8 mL/min/1.73 m; 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.
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.
比较肥胖合并胰岛素治疗 2 型糖尿病（T2D）患者中伴有和不伴有微量白蛋白尿（即 uACR＞3.0mg/mmol）的患者接受减重手术对肾脏、慢性肾脏病（CKD）和心血管（CV）结局的影响。
对来自 The Health Improvement Network（THIN）数据库的 11125 例活跃 T2D 患者进行回顾性队列研究。采用倾向评分匹配（最大 1:6 比例），以确定接受减重手术（N=131）的患者与非减重手术队列（N=579）。随访 10 年（6487 人年），比较心血管事件风险和肾脏结局的差异。
在基线时的匹配队列中：平均年龄 52±13 岁（60%为女性）；体重 116±25kg，体重指数（BMI）41±9kg/m，估算肾小球滤过率（eGFR）为 70.4±20mL/min/1.73m，中位数白蛋白-肌酐比值（uACR）为 2.0mg/mmol（四分位距（IQR）：0.9-5.2mg/mmol）。与匹配的非减重手术队列相比，减重手术可使 CKD 发展风险降低 54%（校正后危险比[aHR]：0.46；95%CI：0.24-0.85，P=0.02）。在基线时伴有微量白蛋白尿的患者中，减重手术对 CKD 有保护作用（aHR：0.42，95%CI：0.18-0.99，P=0.050）。eGFR 在 75%的随访时间内均显著高于基线水平，有利于减重组（两组间计算的平均差异：4.1mL/min/1.73m；P＜0.05），尤其是在 5 年时（74.2 与 67.8mL/min/1.73m；P＜0.001）。然而，非致命性 CVD 事件无显著变化（aHR：0.36，95%CI：0.11-1.13，P=0.079）。术后 2 年内白蛋白水平显著降低（3.9 与 4.1g/dL，P＜0.001）。uACR 和总蛋白水平与干预措施几乎没有统计学关联。
减重手术可能对合并或不合并微量白蛋白尿的糖尿病患者预防 CKD 风险，并对非致命性 CVD 风险具有适度的保护作用。减重手术还与 eGFR 等整体肾脏结局的改善相关。
