Henao-Carrillo Diana Cristina, Jurado-Florez Mayra Alejandra, Muñoz Óscar Mauricio
Pontificia Universidad Javeriana Bogotá Colombia.
Endocrinology Unit Hospital Universitario San Ignacio Bogotá Colombia.
Obes Sci Pract. 2024 Aug 10;10(4):e782. doi: 10.1002/osp4.782. eCollection 2024 Aug.
Metabolic and bariatric surgery (MBS) reduces glomerular hyperfiltration. The renoprotective effects of GLP-1 analogs were derived from clinical studies in type 2 diabetes (T2D). The objective of this study was to evaluate the changes in glomerular filtration rate (GFR) over time associated with weight loss in patients with a BMI ≥ 35 kg/m treated with liraglutide compared with patients treated with MBS.
A longitudinal study derived from a retrospective cohort of patients with BMI ≥ 35 kg/m treated with either MBS or liraglutide 3 mg/day, with follow-up ≥1 year. Clinical variables, baseline GFR, and 1-year GFR were analyzed. A generalized estimating equation (GEE) model was used to compare changes in GFR between both groups while controlling for confounding variables.
A total of 159 patients were included in the analysis. Of these, 129 patients underwent MBS (median age 60.5 years [IQR 51.8-66.6], body mass index (BMI) 40.9 kg/m2 [IQR 0.68-0.89]), and 30 patients were treated with liraglutide (median age 56 years [IQR 46-62], BMI 37.4 kg/m [IQR 0.69-0.93]). No difference in baseline GFR or at 12 months of follow-up was found between the two interventions. GEE analysis revealed an increase of 0.32 mL/min/1.73 m per month of follow-up. Factors associated with a greater increase in GFR were the percentage total weight loss (%TWL) (0.12 mL/min/1.73 m, = 0.023) and baseline GFR (0.69 mL/min/1.73 m, > 0.001) for both interventions, independent of a history of T2D.
In patients with BMI ≥ 35 kg/m, changes in GFR are related to %TWL and baseline GFR, regardless of the presence of diabetes or the type of intervention used.
代谢与减重手术（MBS）可降低肾小球高滤过。胰高血糖素样肽-1（GLP-1）类似物的肾脏保护作用源自2型糖尿病（T2D）的临床研究。本研究的目的是评估与接受利拉鲁肽治疗的体重指数（BMI）≥35 kg/m²患者相比，接受MBS治疗的患者体重减轻过程中肾小球滤过率（GFR）随时间的变化情况。
一项纵向研究，源于对接受MBS或每日3 mg利拉鲁肽治疗的BMI≥35 kg/m²患者的回顾性队列研究，随访时间≥1年。分析临床变量、基线GFR和1年GFR。使用广义估计方程（GEE）模型在控制混杂变量的同时比较两组GFR的变化。
共有159例患者纳入分析。其中，129例患者接受了MBS（中位年龄60.5岁[四分位间距51.8 - 66.6]，体重指数（BMI）40.9 kg/m²[四分位间距0.68 - 0.89]），30例患者接受利拉鲁肽治疗（中位年龄56岁[四分位间距46 - 62]，BMI 37.4 kg/m²[四分位间距0.69 - 0.93]）。两种干预措施在基线GFR或随访12个月时均未发现差异。GEE分析显示，随访期间每月GFR增加0.32 mL/min/1.73 m²。两种干预措施中，与GFR更大增加相关的因素是总体重减轻百分比（%TWL）（0.12 mL/min/1.73 m²，P = 0.023）和基线GFR（0.69 mL/min/1.73 m²，P > 0.001），与T2D病史无关。
在BMI≥35 kg/m²的患者中，GFR的变化与%TWL和基线GFR相关，无论是否存在糖尿病或所采用的干预类型。
