LeAnne Young1, Zubaidah Nor Hanipah, MD2, Stacy A Brethauer, MD2, Philip R Schauer, MD2, Ali Aminian, MD2. 1Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, 2Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio
Introduction: Bariatric surgery significantly improves glycemic control in patients with type 2 diabetes. However, limited literature is available on the impact of bariatric surgery on end-organ complications of diabetes including diabetic nephropathy. The aim of this study was to assess the long-term renoprotective effects of bariatric surgery in patients with type 2 diabetes.
Methods: After IRB approval, clinical data of all diabetic patients with nephropathy who had bariatric surgery at an academic center between 2005 and 2014 were reviewed. Only patients with preoperative albuminuria evident by urine albumin:creatinine ratio (uACR) ≥30 mg/g were included. All these patients were followed up for at least 12 months after the bariatric surgery. Data collected included patient demographics, perioperative data, pre- and post-operative weight, body mass index (BMI), uACR and glycated hemoglobin (HbA1c). Data were summarized as mean with standard deviation for continuous variables, median and interquartile range for uACR changes, and counts with percentages for categorical variables.
Results: Out of 1200 diabetic patients, 101 (8.4%) patients had pre-operative albuminuria and were followed up for albuminuria after bariatric surgery. Of this group, fifty-seven (56%) were female with a mean age of 53 (± 11) years. The mean preoperative BMI was 43 (± 9) kg/m2 and mean preoperative HbA1c was 8.5 (± 1.8) percent. Bariatric procedures performed were Roux-en-Y gastric bypass (n=75, 74%) and sleeve gastrectomy (n=26, 26%). The mean follow up period was 61 (±29) months. At 1 year follow up, the mean BMI dropped by 10 to 32 (±9) kg/m2. The overall glycemic control improved during the follow up period; the mean HbA1c was 6.7 (±1.5) percent at 1-year and 6.8 (±1.1) percent at last follow up period. The median preoperative uACR was 90 (IQR 45 to 240) mg/g. At last follow up, the median change in uACR was -44 (IQR -126 to +3) mg/g. Forty-nine (49%) patients had a resolution of the albuminuria by last follow up and seventy-five (74%) patients had overall uACR improvement.
Conclusion: Findings of this study, which is the largest series of bariatric surgery in patients with diabetic nephropathy to date, showed a high resolution rate of albuminuria (in almost 50% of patients) in the intermediate to long term postoperative follow up.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87493
Program Number: S038
Presentation Session: Bariatrics 2 Session
Presentation Type: Podium
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