Bariatric Surgery Reverses Diabetic Nephropathy

Bariatric surgery induces a significant and lasting improvement in diabetic nephropathy, with nearly 60% of patients with this condition achieving remission five years after surgery, according to a new study.

Researchers at the Cleveland Clinic (OH, USA) examined the five-year outcomes of 52 diabetic patients (75% women, mean age of 51.2 years) who underwent bariatric surgery at the Cleveland Clinic. The patients had a median preoperative body mass index (BMI) of 49 kg/m2. Before surgery, 37.6% of the patients had diabetic nephropathy, as indicated by microalbuminuria (30-299 mg/g creatinine) or macroalbuminuria (over 300 mg/g creatinine). No preoperative differences in the mean urinary albumin levels were found between patients who were prescribed a renoprotective agent and those who were not.

The results showed that after bariatric surgery, nephropathy resolved in 58.3% of the patients at a mean follow-up of 66 months, with both microalbuminuria and macroalbuminuria patients experiencing similar improvements in nephropathy. Overall, diabetes resolved in 44% of patients and one-third of patients experienced an improvement in their diabetes. Patients who had no improvement in diabetes showed the least weight loss after five years; they also had the highest levels of glycosylated hemoglobin (HbA1c) five years after surgery at 7.9%, in contrast to 5.9% among those with resolved diabetes, and 6.9% among those with improvements in diabetes. The study was presented at the annual meeting of the American Society for Metabolic and Bariatric Surgery (ASMBS), held during November 2012 in San Diego (CA, USA).

“When we started this study, we thought bariatric surgery may just halt the progression of diabetic nephropathy. Instead, over half the patients who had diabetic nephropathy prior to undergoing bariatric surgery experienced remission,” said lead author and study presenter Helen Heneghan, MD. “The finding warrants greater consideration of bariatric surgery in patients with diabetic kidney disease.”

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