Bariatric is the best treatment for kidney patients with diabetes and obesity, says study

Bariatric surgery, also called metabolic surgery, represents the best treatment available for kidney patients with type 2 diabetes and obesity, according to an unprecedented study carried out in Brazil.

The research showed that, up to five years after the surgical procedure, 69.7% of the patients showed improvement in their renal condition. When compared with the best drug treatment available, 59.6% of patients had the same performance.

Although small, the difference is significant, indicating that metabolic surgery can be considered the best treatment for these conditions in terms of recovery of renal function and gain in quality of life.

The study, led by the physician and coordinator of the Obesity and Diabetes Center at the Hospital Alemão Oswaldo Cruz, Ricardo Cohen, was published in the specialized journal eClinical Medicine (from the Lancet group) on the 11th.

Scientists from the HCor Research Institute (Hospital do Coração) in São Paulo, St. Michael, from Toronto (Canada), from the Indiana University School of Medicine (USA), and from the Universities of Leicester, Ulster and College of Dublin, in the United Kingdom.

To assess the effects of bariatric surgery on chronic kidney disease, researchers evaluated 100 patients in 2016, of which 49 underwent drug treatment and 51 underwent bariatric surgery. Another 92 patients were followed up as a control group.

After one year, the reduction in the microalbuminuria indicator (which indicates loss of protein in the urine due to kidney failure) in patients who underwent bariatric surgery was more than 75%, while patients treated with medication had about a 60% reduction.

The reduction was accentuated up to one year after surgery in patients who underwent surgery, while in those treated with traditional conventional therapy there was a worsening of progress.

In addition, the improvement in quality of life was greater in patients who underwent surgery, and they also showed significant weight reduction when compared to those treated with medicine (90% against 22.5%).

For Cohen, the study is unprecedented in showing that bariatric surgery outperforms the best medication available. “And, after five years, we saw that it is a safe surgery, with few side effects, with an improvement in quality of life and, in the long term, it is more cost-effective, because the patient stops spending money on medication” , argues.

According to him, bariatrics should not necessarily compete with drug treatment —generally done through hemodialysis—, but be an option for individualized treatment. “It is another option for the seriously ill patient. As both options have good results, it is possible, in a patient with obesity 1, to have the surgery already done to avoid aggravating the renal complication. he.

Among the most effective drugs used for chronic kidney disease are angiotensin-converting enzyme 2 (ACE2) inhibitors and renin-angiotensin-aldosterone system (ARB) blockers, in addition to other inhibitors that act, for example, on the sodium-cotransport system. glucose 2 (called SGLT2).

Since 2017, the Federal Council of Medicine has recognized bariatric surgery as a treatment option for patients with type 2 diabetes, with or without morbid obesity, to reduce pressure on kidney function. According to the general director of the Brazilian Society of Nephrology, Andrea Pio de Abreu, it has already been demonstrated that surgery is an effective option for kidney patients with diabetes.

“We have already managed to demonstrate that bariatric surgery helps not only in weight control, but in the treatment of patients with diabetes, managing to reduce and even improve 100% the loss of protein in the urine”, says Abreu.

The Oswaldo Cruz hospital study itself resulted in a reduction in diabetic kidney disease in 63.1% of post-surgery patients, while in those undergoing dialysis the reduction was 52.8%.

Still according to Abreu, more than half of the cases of chronic kidney disease are caused by arterial hypertension (from 30% to 33%) and type 2 diabetes (30%). “It is important that people understand the causes, because kidney disease is asymptomatic until an advanced stage, when there is already a loss of kidney function. Controlling risk factors is essential for prevention”, he explains.

As there is no cure, it is only possible to reduce the progression of the disease, Abreu recalls that the increase in the prevalence of diabetes and obesity in the country is a cause for concern. Data from Vigitel 2021 indicate that almost 16 million adults in the country, or 9% of the population, live with diabetes, while the share of obese Brazilians should reach 30% of the population by 2030.

For the physician, as there is an increased risk of needing a kidney transplant in patients with obesity (body mass index equal to or greater than 32), the secondary effect of reducing body weight brings yet another advantage of metabolic surgery.

“It is important to analyze each candidate individually, but what we are seeing is a great therapeutic option that will share the front with the chronic renal patient who needs dialysis”, says Abreu.