Urinary Metabolomic Changes Accompanying Albuminuria Remission following Gastric Bypass Surgery for Type 2 Diabetic Kidney Disease

• In the Microvascular Outcomes after Metabolic Surgery randomised clinical trial (MOMS RCT, NCT01821508), combined metabolic surgery (gastric bypass) plus medical therapy (CSM) was superior to medical therapy alone (MTA) as a means of achieving albuminuria remission at 2‐year follow‐up in patients with obesity and early diabetic kidney disease (DKD). In the present study, we assessed the urinary1H‐NMR metabolome in a subgroup of patients from both arms of the MOMS RCT at baseline and 6‐month follow‐up. Whilst CSM and MTA both reduced the urinary excretion of sugars, CSM generated a distinctive urinary metabolomic profile characterised by increases in host–microbial co‐metabolites (N‐phenylacetylglycine, trimethylamine N‐oxide, and 4‐ aminobutyrate (GABA)) and amino acids (arginine and glutamine). Furthermore, reductions in aromatic amino acids (phenylalanine and tyrosine), as well as branched‐chain amino acids (BCAAs) and related catabolites (valine, leucine, 3‐hydroxyisobutyrate, 3‐hydroxyisovalerate, and 3‐methyl‐ 2‐oxovalerate), were observed following CSM but not MTA. Improvements in BMI did not correlate with improvements in metabolic and renal indices following CSM. Conversely, urinary metabolites changed by CSM at 6 months were moderately to strongly correlated with improvements in blood pressure, glycaemia, triglycerides, and albuminuria up to 24 months following treatment initiation, highlighting the potential involvement of these shifts in the urinary metabolomic profile in the metabolic and renoprotective effects of CSM. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Endokrinologi och diabetes (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Endocrinology and Diabetes (hsv//eng)

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Gastroenterologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Gastroenterology and Hepatology (hsv//eng)

Nyckelord

Albuminuria

Bariatric surgery

BCAA

Chronic kidney disease

Diabetic kidney disease

Gastric bypass

Metabolomics

NMR spectroscopy

Obesity

Type 2 diabetes

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