Vasileios Liakopoulos1,2, Stefan Franzén3,4, Ann-Marie Svensson5,3, Naveed Sattar6, Mervete Miftaraj3, Staffan Björck3, Johan Ottosson7, Ingmar Näslund7, Soffia Gudbjörnsdottir5,3, Björn Eliasson5,2. 1. Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden vasileios.liakopoulos@vgregion.se. 2. Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden. 3. National Diabetes Register, Center of Registers, Gothenburg, Sweden. 4. Health Metrics Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 5. Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden. 6. The Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K. 7. Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Abstract
OBJECTIVE: We examined detailed renal and cardiovascular (CV) outcomes after gastric bypass (GBP) surgery in people with obesity and type 2 diabetes mellitus (T2DM), across several renal function categories, in a nationwide cohort study. RESEARCH DESIGN AND METHODS: We linked data from the National Diabetes Register and the Scandinavian Obesity Surgery Register with four national databases holding information on socioeconomic variables, medications, hospitalizations, and causes of death and matched 5,321 individuals with T2DM who had undergone GBP with 5,321 who had not (age 18-65 years, mean BMI >40 kg/m2, mean follow-up >4.5 years). The risks of postoperative outcomes were assessed with Cox regression models. RESULTS: During the first years postsurgery, there were small reductions in creatinine and albuminuria and stable estimated glomerular filtration rate (eGFR) in the GBP group. The incidence rates of most outcomes relating to renal function, CV disease, and mortality were lower after GBP, being particularly marked for heart failure (hazard ratio [HR] 0.33 [95% CI 0.24, 0.46]) and CV mortality (HR 0.36 [(95% CI 0.22, 0.58]). The risk of a composite of severe renal disease or halved eGFR was 0.56 (95% CI 0.44, 0.71), whereas nonfatal CV risk was lowered less (HR 0.82 [95% CI 0.70, 0.97]) after GBP. Risks for key outcomes were generally lower after GBP in all eGFR strata, including in individuals with eGFR <30 mL/min/1.73 m2. CONCLUSIONS: Our data suggest robust benefits for renal outcomes, heart failure, and CV mortality after GBP in individuals with obesity and T2DM. These results suggest that marked weight loss yields important benefits, particularly on the cardiorenal axis (including slowing progression to end-stage renal disease), whatever the baseline renal function status.
OBJECTIVE: We examined detailed renal and cardiovascular (CV) outcomes after gastric bypass (GBP) surgery in people with obesity and type 2 diabetes mellitus (T2DM), across several renal function categories, in a nationwide cohort study. RESEARCH DESIGN AND METHODS: We linked data from the National Diabetes Register and the Scandinavian Obesity Surgery Register with four national databases holding information on socioeconomic variables, medications, hospitalizations, and causes of death and matched 5,321 individuals with T2DM who had undergone GBP with 5,321 who had not (age 18-65 years, mean BMI >40 kg/m2, mean follow-up >4.5 years). The risks of postoperative outcomes were assessed with Cox regression models. RESULTS: During the first years postsurgery, there were small reductions in creatinine and albuminuria and stable estimated glomerular filtration rate (eGFR) in the GBP group. The incidence rates of most outcomes relating to renal function, CV disease, and mortality were lower after GBP, being particularly marked for heart failure (hazard ratio [HR] 0.33 [95% CI 0.24, 0.46]) and CV mortality (HR 0.36 [(95% CI 0.22, 0.58]). The risk of a composite of severe renal disease or halved eGFR was 0.56 (95% CI 0.44, 0.71), whereas nonfatal CV risk was lowered less (HR 0.82 [95% CI 0.70, 0.97]) after GBP. Risks for key outcomes were generally lower after GBP in all eGFR strata, including in individuals with eGFR <30 mL/min/1.73 m2. CONCLUSIONS: Our data suggest robust benefits for renal outcomes, heart failure, and CV mortality after GBP in individuals with obesity and T2DM. These results suggest that marked weight loss yields important benefits, particularly on the cardiorenal axis (including slowing progression to end-stage renal disease), whatever the baseline renal function status.
Authors: Karen J Coleman; Yu-Hsiang Shu; Heidi Fischer; Eric Johnson; Tae K Yoon; Brianna Taylor; Talha Imam; Stephen DeRose; Sebastien Haneuse; Lisa J Herrinton; David Fisher; Robert A Li; Mary Kay Theis; Liyan Liu; Anita P Courcoulas; David H Smith; David E Arterburn; Allon N Friedman Journal: Ann Surg Date: 2021-03-03 Impact factor: 13.787
Authors: Sophie L van Veldhuisen; Thomas M Gorter; Gijs van Woerden; Rudolf A de Boer; Michiel Rienstra; Eric J Hazebroek; Dirk J van Veldhuisen Journal: Eur Heart J Date: 2022-05-21 Impact factor: 35.855