The effects of metabolic surgery versus the use of glucagon-like peptide-1 receptor agonists (GLP-1RA) in patients with chronic kidney disease (CKD) have not been well described. Therefore, Ali Aminian, MD, and colleagues studied the renoprotective advantages of metabolic surgery in patients with obesity and CKD compared to patients who did not have surgery but continuously received GLP-1RA.
Participants had type 2 diabetes, obesity (defined as BMI ≥30 kg/m2), and baseline eGFR 20-60 mL/min/1.73 m². Patients who had metabolic bariatric surgery at a large US health system between 2010 and 2017 were compared to nonsurgical patients who continuously received GLP-1RA.
The primary endpoint of the study was CKD progression, defined as an eGFR decline of ≥50% or decline to <15 mL/min/1.73 m2, initiation of dialysis, or kidney transplant. The secondary endpoint was concurrent kidney failure (eGFR <15 mL/min/1.73 m2, dialysis, or kidney transplant) or all-cause mortality. A total of 425 patients were studied, including 183 in the metabolic surgery group and 242 in the GLP-1RA group. The median follow-up period was 5.8 years (IQR, 4.4-7.6).
At eight years, the cumulative incidence of the primary endpoint was 21.7% (95% CI, 12.2-30.6) in the surgical group and 45.1% (95% CI, 27.7-58.4) in the nonsurgical group (adjusted HR [aHR], 0.40; 95% CI, 0.21-0.76; P=.006). The cumulative incidence of the secondary composite endpoint at eight years was 24.0% (95% CI, 14.1-33.2) in the surgical group and 43.8% (95% CI, 28.1-56.1) in the nonsurgical group (aHR, 0.56; 95% CI, 0.31-0.99; P=.048).
In conclusion, metabolic surgery was significantly associated with a 60% lower risk of progression of kidney damage and a 44% lower risk of kidney failure or death compared to GLP-1RA in patients with type 2 diabetes, obesity, and CKD. “Metabolic surgery should be considered as a therapeutic option for patients with CKD and obesity,” the authors wrote.
Source: Annals of Surgery.
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