title: The impact of bariatric surgery on estimated glomerular filtration rate in patients with type 2 diabetes: a retrospective cohort study.
abstract: BACKGROUND
  Diabetes mellitus is the most common cause of end-stage renal disease, which is associated with increased morbidity and mortality. The impact of bariatric surgery on chronic kidney disease is unclear.
  
  
  OBJECTIVE
  Our primary aim was to assess the impact of bariatric surgery on estimated glomerular filtration rate (eGFR) in type 2 diabetes (T2D) patients. Our secondary aim was to compare the impact of bariatric surgery versus routine care on eGFR in patients with T2D.
  
  
  METHODS
  University Hospital, United Kingdom.
  
  
  METHODS
  A retrospective cohort analysis of adults with T2D who underwent bariatric surgery at a single center between January 2005 and December 2012. Data regarding eGFR were obtained from electronic patients records. eGFR was calculated using the Modification of Diet in Renal Disease formula. Data regarding patients with T2D who did not undergo bariatric surgery ("routine care") were obtained from patients attending the diabetes clinic at the same center from 2009 to 2011.
  
  
  RESULTS
  One hundred sixty-three patients were included (mean age 48.5±8.8 yr; baseline body mass index 50.8±9.1 kg/m2) and were followed for 3.0±2.3 years. Bariatric surgery resulted in an improvement in eGFR (median [interquartile range] 86.0 [73.0-100.0] versus 92.0 [77.0-101.0] mL/min/1.73 m2for baseline versus follow-up, respectively; P = .003), particularly in patients with baseline eGFR≤60 mL/min/1.73 m2(48.0 [42.0-57.0] versus 61.0 [55.0-63.0] mL/min/1.73 m2; P = .004). After adjusting for baseline eGFR, glycated hemoglobin (HbA1C), body mass index, age, and gender, bariatric surgery was associated with higher study-end eGFR compared with routine care (B = 7.787; P< .001).
  
  
  CONCLUSIONS
  Bariatric surgery results in significant improvements in eGFR in T2D patients, particularly those with an eGFR≤60 mL/min/1.73 m2, while routine care was associated with a decline in eGFR.
authors: School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, United Kingdom.
authors: Nikhil
authors: N
authors: Mirajkar
authors: Aston Research Centre for Healthy Ageing (ARCHA), Aston University, Birmingham, United Kingdom; Department of Diabetes and Endocrinology, Birmingham Heartlands Hospital, Birmingham, United Kingdom.
authors: Srikanth
authors: S
authors: Bellary
authors: Department of Diabetes and Endocrinology, Birmingham Heartlands Hospital, Birmingham, United Kingdom.
authors: Mohamed
authors: M
authors: Ahmed
authors: Department of Upper Gastrointestinal Surgery, Birmingham Heartlands Hospital, Birmingham, United Kingdom.
authors: Rishi
authors: R
authors: Singhal
authors: Department of Upper Gastrointestinal Surgery, Birmingham Heartlands Hospital, Birmingham, United Kingdom.
authors: Markos
authors: M
authors: Daskalakis
authors: Department of Diabetes and Endocrinology, Birmingham Heartlands Hospital, Birmingham, United Kingdom; Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom. Electronic address: Abd.tahrani@nhs.net.
authors: Abd A
authors: AA
authors: Tahrani
mesh_terms: D000419:Albuminuria / Q000503:physiopathology; D050110:Bariatric Surgery; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000503:physiopathology / Q000601:surgery; D051436:Renal Insufficiency, Chronic / Q000503:physiopathology / Q000601:surgery; D012189:Retrospective Studies
chemical_list: D006442:Glycated Hemoglobin
keywords: Albuminuria; Bariatric surgery; Chronic kidney disease; Estimated glomerular filtration rate; Nephropathy; Renal function; Type 2 diabetes