Effect of Bariatric Surgery on Diagnosed Chronic Kidney Disease and Cardiovascular Events in Patients with Insulin-treated Type 2 Diabetes: a Retrospective Cohort Study from a Large UK Primary Care Database

Alkharaiji, Mohammed; Anyanwagu, Uchenna; Donnelly, Richard; Idris, Iskandar

Abstract

Aims: 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).

Methods: 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 (6,487 person-years) to compare differences in risk of cardiovascular events and in renal outcomes.

Results: For the matched cohort at baseline: mean age 52±13 years (60% female); weight 116±25kg, Body Mass Index (BMI) 41±9kg/m2, estimated Glomerular Filtration Rate (eGFR); 70.4±20mL/min/1.73m2, 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: 4.1mL/min/1.73m2; P

Citation

Alkharaiji, M., Anyanwagu, U., Donnelly, R., & Idris, I. (2020). Effect of Bariatric Surgery on Diagnosed Chronic Kidney Disease and Cardiovascular Events in Patients with Insulin-treated Type 2 Diabetes: a Retrospective Cohort Study from a Large UK Primary Care Database. Obesity Surgery, 30(5), 1685–1695. https://doi.org/10.1007/s11695-019-04201-y

• Journal Article Type: Article
• Acceptance Date: Sep 18, 2019
• Online Publication Date: Mar 4, 2020
• Publication Date: May 1, 2020
• Deposit Date: Nov 14, 2019
• Publicly Available Date: Mar 5, 2021
• Journal: Obesity Surgery
• Print ISSN: 0960-8923
• Electronic ISSN: 1708-0428
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 30
• Issue: 5
• Pages: 1685–1695
• DOI: https://doi.org/10.1007/s11695-019-04201-y
• Keywords: Surgery; Nutrition and Dietetics; Endocrinology, Diabetes and Metabolism
• Public URL: https://nottingham-repository.worktribe.com/output/3282600
• Publisher URL: https://link.springer.com/article/10.1007%2Fs11695-019-04201-y