A recent study conducted by the Cleveland Clinic reveals that bariatric surgery is significantly more effective in reducing the progression of chronic kidney disease in individuals with obesity and diabetes compared to GLP-1 drugs. The research found that patients who underwent bariatric surgery had a 60% lower risk of kidney impairment progression and a 44% lower risk of kidney failure or death.
Chronic kidney disease (CKD) is a serious health condition that often develops as a result of type 2 diabetes, particularly in those with obesity. CKD is a major cause of health complications and mortality in these patients. The study highlights bariatric surgery as a promising intervention for reducing the progression of kidney disease in individuals with obesity and diabetes.
Bariatric surgery, specifically gastric sleeve surgery, reduces the size of the stomach by approximately 80%. This reduction not only limits food intake but also leads to metabolic changes that decrease the sensation of hunger, making it easier for individuals to manage their weight. By addressing obesity, bariatric surgery helps tackle one of the root causes of kidney disease and type 2 diabetes.
The study, published in the Annals of Surgery, involved 425 participants. Of these, 183 underwent bariatric surgery, while 242 were treated with GLP-1 drugs, which also aid in weight loss. Participants were followed for a median duration of 5.8 years. The results showed that bariatric surgery was more closely associated with a reduction in the progression of chronic kidney disease compared to GLP-1 drugs.
Dr. Mir Ali, a board-certified bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center, explained that obesity exerts stress on all of the body's organs and increases the likelihood of developing type 2 diabetes, which can further damage the kidneys if not managed well. However, not all individuals with diabetes will develop chronic kidney disease, as other hereditary or congenital factors can also contribute to its development.
Dr. Raj Dasgupta, chief medical advisor for Fortune Recommends Health, pointed out that while bariatric surgery is not typically the first choice for treating individuals with obesity and chronic kidney disease, it is becoming more common for those with severe obesity, especially if diabetes is present. However, qualifying for surgery coverage from insurance companies in the United States requires meeting specific criteria, including a body mass index (BMI) between 35 and 40 without other medical conditions.
Although GLP-1 drugs can help control diabetes and support weight loss, they do not produce the metabolic changes seen with bariatric surgery. Dr. Ali explained that the gastric sleeve procedure removes parts of the stomach that produce hunger hormones, such as ghrelin. This reduction in hormone levels leads to a decreased sensation of hunger, allowing patients to eat less without feeling deprived.
Dr. Dasgupta added that these metabolic changes contribute to improved overall health and help protect the kidneys by managing diabetes and other risk factors that can damage them. Bariatric surgery also offers more durable weight loss outcomes than current medications. According to Dr. Ali, long-term success rates for bariatric surgery are around 80%, significantly higher than the 2-5% success rate with diet and exercise alone. The long-term effectiveness of GLP-1 drugs is not yet fully understood, but it is expected to be better than diet and exercise, though not as effective as bariatric surgery.
The findings from this study suggest that bariatric surgery could be a more viable option for reducing chronic kidney disease progression in patients with obesity and type 2 diabetes compared to GLP-1 drugs. However, the choice of treatment should be individualized, considering the patient's specific condition and health needs.
Reference:
1. Surgery, *Department of General. “Renoprotective Effects of Metabolic Surgery versus GLP1... : Annals of Surgery.” LWW. Accessed October 4, 2024. https://journals.lww.com/annalsofsurgery/fulltext/2024/09000/renoprotective_effects_of_metabolic_surgery_versus.7.aspx.
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