Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong SAR, China.
Department of Surgery, Prince of Wales Hospital, Hong Kong SAR, China.
Nephrol Dial Transplant. 2021 Jul 23;36(8):1440-1451. doi: 10.1093/ndt/gfaa075.
Bariatric surgery has been widely indicated for the management of obesity and related comorbidities. However, there are uncertainties pertaining to the risks of post-bariatric severe hypoglycaemia (SH), cardiovascular diseases (CVDs), end-stage kidney diseases (ESKDs) and all-cause mortality in obese patients with Type 2 diabetes mellitus (T2DM), especially among Asian populations.
A retrospective population-based cohort of 1702 obese T2DM patients who were free of CVD and ESKD were assembled based on the 2006-17 Hospital Authority database. One-to-five propensity-score matching was used to balance baseline covariates between patients in bariatric surgery and control groups. Incidence rates (IRs) of SH, CVD, Stage 4/5 chronic kidney diseases (CKD), ESKD and all-cause mortality events for two groups were calculated. Hazard ratios (HR) for SH, CVD and Stage 4/5 CKD events were assessed using Cox-proportional hazard models. Changes in estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (UACR) were measured up to 60 months.
Over a mean follow-up period of 32 months with 5725 person-years, cumulative incidences of mortality, CVD, Stage 4/5 CKD, ESKD and SH were 0, 0.036, 0.050, 0.017 and 0.020, respectively. The surgery group had a significant reduction in risk of CVD events (HR = 0.464, P = 0.015) and no occurrence of mortality events. However, there were no significant differences in risks of SH [HR = 0.469, 95% confidence interval (CI): 0.204-1.081], Stage 4/5 CKD (HR =0.896, 95% CI: 0.519-1.545) and ESKD (HR = 0.666, 95% CI: 0.264-1.683) between two groups, although IRs were lower in the surgery group. Surgical patients had significantly higher eGFR within 12 months and had significantly lower UACR until 48 months.
Among obese T2DM patients, bariatric surgery lowered the risk of CVD and mortality, and was beneficial towards the kidney outcomes.
减重手术已被广泛应用于肥胖及其相关合并症的治疗。然而，对于肥胖 2 型糖尿病（T2DM）患者，减重手术后严重低血糖（SH）、心血管疾病（CVD）、终末期肾病（ESKD）和全因死亡率的风险仍存在不确定性，尤其是在亚洲人群中。
本研究基于 2006 年至 2017 年医院管理局数据库，构建了一个由 1702 名肥胖 T2DM 患者组成的回顾性基于人群的队列，这些患者无 CVD 和 ESKD。通过 1:5 倾向评分匹配来平衡手术组和对照组患者的基线协变量。计算两组 SH、CVD、4/5 期慢性肾脏病（CKD）、ESKD 和全因死亡率事件的发生率（IR）。采用 Cox 比例风险模型评估 SH、CVD 和 4/5 期 CKD 事件的风险比（HR）。在 60 个月内测量估算肾小球滤过率（eGFR）和尿白蛋白/肌酐比值（UACR）的变化。
在平均 32 个月的随访期内（共 5725 人年），死亡率、CVD、4/5 期 CKD、ESKD 和 SH 的累积发生率分别为 0、0.036、0.050、0.017 和 0.020。手术组 CVD 事件的风险显著降低（HR=0.464，P=0.015），且无死亡事件发生。然而，两组间 SH（HR=0.469，95%置信区间[CI]：0.204-1.081）、4/5 期 CKD（HR=0.896，95%CI：0.519-1.545）和 ESKD（HR=0.666，95%CI：0.264-1.683）的风险无显著差异，尽管手术组的 IR 较低。手术组在 12 个月内 eGFR 显著升高，在 48 个月内 UACR 显著降低。
在肥胖 T2DM 患者中，减重手术降低了 CVD 和死亡率风险，并有利于肾脏结局。
