Five-year kidney outcomes of bariatric surgery differ in severely obese adolescents and adults with and without type 2 diabetes

Petter Bjornstad; Edward Nehus; Todd Jenkins; Mark Mitsnefes; Marva Moxey-Mims; John B. Dixon; Thomas H. Inge

doi:10.1016/j.kint.2020.01.016

Five-year kidney outcomes of bariatric surgery differ in severely obese adolescents and adults with and without type 2 diabetes

Petter Bjornstad^*, Edward Nehus, Todd Jenkins, Mark Mitsnefes, Marva Moxey-Mims, John B. Dixon, Thomas H. Inge

^*Corresponding author for this work

Surgery

Research output: Contribution to journal › Article › peer-review

16 Scopus citations

Abstract

Bariatric surgery improves markers of kidney health in severe obesity, yet it is unclear if kidney disease outcomes differ according to age at surgery. Therefore, we examined health effects of Roux-en-Y gastric bypass between 161 adolescents and 396 adults participating in two related but distinct studies. Primary outcomes were elevated urine albumin-to-creatinine ratio (UACR) of 30 mg/g or more and hyperfiltration (an estimated glomerular filtration rate of 135 ml/min/1.73m² or more). Analyses were stratified by the presence of pre-operative type 2 diabetes. Adolescents with pre-operative type 2 diabetes had a significantly increased prevalence of elevated UACR prior to surgery compared to adults (22.5 vs. 9.0%). Resolution of elevated UACR following surgery differed between adolescents and adults with type 2 diabetes, with adolescents experiencing a significantly earlier improvement following surgery. Adolescents without pre-operative type 2 diabetes demonstrated a significantly increased prevalence of UACR prior to surgery compared to adults (9.4 vs. 4.5%), with no improvement occurring in either group post-operatively. Adolescents with pre-operative type 2 diabetes had a significantly increased prevalence of hyperfiltration that remained throughout the study period, whereas hyperfiltration prevalence was similar among those without type 2 diabetes. Thus, adolescents with pre-operative type 2 diabetes experienced earlier attenuation of elevated UACR compared to adults with pre-operative type 2 diabetes in response to gastric bypass.

Original language	English (US)
Pages (from-to)	995-1005
Number of pages	11
Journal	Kidney international
Volume	97
Issue number	5
DOIs	https://doi.org/10.1016/j.kint.2020.01.016
State	Published - May 2020

Funding

The Teen-LABS consortium is funded by cooperative agreements with the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), through grants: UM1DK072493 (PI: TI, University of Colorado, Denver, CO), and UM1DK095710 (PI: Changchun Xie, University of Cincinnati, Cincinnati, OH). PB is funded by NIDDK (K23-DK116720), in addition to research support from JDRF (2-SRA-2018-627-M-B, 2-SRA-2019-845-S-B), Thrasher Research Fund, NIH/NIDDK DiaComp, ISPAD, Diabetes Guild, Center for Women’s Health Research at University of Colorado, Children’s Hospital Colorado Research Institute, and Colorado Clinical and Translational Sciences Institute.

Keywords

Roux-en-Y gastric bypass
diabetic kidney disease
elevated albumin excretion
hyperfiltration
metabolic bariatric surgery
type 2 diabetes

ASJC Scopus subject areas

Nephrology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.kint.2020.01.016

Cite this

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title = "Five-year kidney outcomes of bariatric surgery differ in severely obese adolescents and adults with and without type 2 diabetes",

abstract = "Bariatric surgery improves markers of kidney health in severe obesity, yet it is unclear if kidney disease outcomes differ according to age at surgery. Therefore, we examined health effects of Roux-en-Y gastric bypass between 161 adolescents and 396 adults participating in two related but distinct studies. Primary outcomes were elevated urine albumin-to-creatinine ratio (UACR) of 30 mg/g or more and hyperfiltration (an estimated glomerular filtration rate of 135 ml/min/1.73m2 or more). Analyses were stratified by the presence of pre-operative type 2 diabetes. Adolescents with pre-operative type 2 diabetes had a significantly increased prevalence of elevated UACR prior to surgery compared to adults (22.5 vs. 9.0%). Resolution of elevated UACR following surgery differed between adolescents and adults with type 2 diabetes, with adolescents experiencing a significantly earlier improvement following surgery. Adolescents without pre-operative type 2 diabetes demonstrated a significantly increased prevalence of UACR prior to surgery compared to adults (9.4 vs. 4.5%), with no improvement occurring in either group post-operatively. Adolescents with pre-operative type 2 diabetes had a significantly increased prevalence of hyperfiltration that remained throughout the study period, whereas hyperfiltration prevalence was similar among those without type 2 diabetes. Thus, adolescents with pre-operative type 2 diabetes experienced earlier attenuation of elevated UACR compared to adults with pre-operative type 2 diabetes in response to gastric bypass.",

keywords = "Roux-en-Y gastric bypass, diabetic kidney disease, elevated albumin excretion, hyperfiltration, metabolic bariatric surgery, type 2 diabetes",

author = "Petter Bjornstad and Edward Nehus and Todd Jenkins and Mark Mitsnefes and Marva Moxey-Mims and Dixon, {John B.} and Inge, {Thomas H.}",

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AU - Moxey-Mims, Marva

AU - Dixon, John B.

AU - Inge, Thomas H.

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AB - Bariatric surgery improves markers of kidney health in severe obesity, yet it is unclear if kidney disease outcomes differ according to age at surgery. Therefore, we examined health effects of Roux-en-Y gastric bypass between 161 adolescents and 396 adults participating in two related but distinct studies. Primary outcomes were elevated urine albumin-to-creatinine ratio (UACR) of 30 mg/g or more and hyperfiltration (an estimated glomerular filtration rate of 135 ml/min/1.73m2 or more). Analyses were stratified by the presence of pre-operative type 2 diabetes. Adolescents with pre-operative type 2 diabetes had a significantly increased prevalence of elevated UACR prior to surgery compared to adults (22.5 vs. 9.0%). Resolution of elevated UACR following surgery differed between adolescents and adults with type 2 diabetes, with adolescents experiencing a significantly earlier improvement following surgery. Adolescents without pre-operative type 2 diabetes demonstrated a significantly increased prevalence of UACR prior to surgery compared to adults (9.4 vs. 4.5%), with no improvement occurring in either group post-operatively. Adolescents with pre-operative type 2 diabetes had a significantly increased prevalence of hyperfiltration that remained throughout the study period, whereas hyperfiltration prevalence was similar among those without type 2 diabetes. Thus, adolescents with pre-operative type 2 diabetes experienced earlier attenuation of elevated UACR compared to adults with pre-operative type 2 diabetes in response to gastric bypass.

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Five-year kidney outcomes of bariatric surgery differ in severely obese adolescents and adults with and without type 2 diabetes

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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