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Sökning: WFRF:(Aboud S) > (2020-2022) > Effect of Gastric B...

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FältnamnIndikatorerMetadata
00005094naa a2200661 4500
001oai:gup.ub.gu.se/296625
003SwePub
008240528s2020 | |||||||||||000 ||eng|
0247 a https://gup.ub.gu.se/publication/2966252 URI
0247 a https://doi.org/10.1001/jamasurg.2020.04202 DOI
040 a (SwePub)gu
041 a eng
042 9 SwePub
072 7a ref2 swepub-contenttype
072 7a art2 swepub-publicationtype
1001 a Cohen, R. V.4 aut
2451 0a Effect of Gastric Bypass vs Best Medical Treatment on Early-Stage Chronic Kidney Disease in Patients With Type 2 Diabetes and Obesity A Randomized Clinical Trial
264 c 2020-08-19
264 1b American Medical Association (AMA),c 2020
520 a IMPORTANCE Early-stage chronic kidney disease (CKD) characterized by microalbuminuria is associated with future cardiovascular events, progression toward end-stage renal disease, and early mortality in patients with type 2 diabetes. OBJECTIVE To compare the albuminuria-lowering effects of Roux-en-Y gastric bypass (RYGB) surgery vs best medical treatment in patients with early-stage CKD, type 2 diabetes, and obesity. DESIGN, SETTING, AND PARTICIPANTS For this randomized clinical trial, patients with established type 2 diabetes and microalbuminuria were recruited from a single center from April 1, 2013, through March 31, 2016, with a 5-year follow-up, including prespecified intermediate analysis at 24-month follow-up. INTERVENTION A total of 100 patients with type 2 diabetes, obesity (body mass indexes of 30 to 35 [calculated as weight in kilograms divided by height in meters squared]), and stage G1 to G3 and A2 to A3 CKD (urinary albumin-creatinine ratio [uACR] >30 mg/g and estimated glomerular filtration rate >30 mL/min) were randomized 1:1 to receive best medical treatment (n = 49) or RYGB (n = 51). MAIN OUTCOMES AND MEASURES The primary outcome was remission of albuminuria (uACR <30 mg/g). Secondary outcomes were CKD remission rate, absolute change in uACR, metabolic control, other microvascular complications, quality of life, and safety. RESULTS A total of 100 patients (mean [SD] age, 51.4 [7.6] years; 55 [55%] male) were randomized: 51 to RYGB and 49 to best medical care. Remission of albuminuria occurred in 55% of patients (95% CI, 39%-70%) after best medical treatment and 82% of patients (95% CI, 72%-93%) after RYGB (P = .006), resulting in CKD remission rates of 48% (95% CI, 32%-64%) after best medical treatment and 82% (95% CI, 72%-92%) after RYGB (P = .002). The geometric mean uACRs were 55% lower after RYGB (10.7 mg/g of creatinine) than after best medical treatment (23.6 mg/g of creatinine) (P < .001). No difference in the rate of serious adverse events was observed. CONCLUSIONS AND RELEVANCE After 24 months, RYGB was more effective than best medical treatment for achieving remission of albuminuria and stage G1 to G3 and A2 to A3 CKD in patients with type 2 diabetes and obesity.
650 7a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Kirurgi0 (SwePub)302122 hsv//swe
650 7a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Surgery0 (SwePub)302122 hsv//eng
650 7a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Gastroenterologi0 (SwePub)302132 hsv//swe
650 7a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Gastroenterology and Hepatology0 (SwePub)302132 hsv//eng
653 a cardiovascular outcomes
653 a sleeve gastrectomy
653 a bariatric surgery
653 a weight-loss
653 a risk
653 a albuminuria
653 a complications
653 a association
653 a proteinuria
653 a prevalence
653 a Surgery
7001 a Pereira, T. V.4 aut
7001 a Aboud, C. M.4 aut
7001 a Petry, T. B. Z.4 aut
7001 a Correa, J. L. L.4 aut
7001 a Schiavon, C. A.4 aut
7001 a Pompilio, C. E.4 aut
7001 a Pechy, F. N. Q.4 aut
7001 a Silva, Accd4 aut
7001 a de Melo, F. L. G.4 aut
7001 a da Silveira, L. P. C.4 aut
7001 a Caravatto, P. P. D.4 aut
7001 a Halpern, H.4 aut
7001 a Monteiro, F. D. J.4 aut
7001 a Martins, B. D.4 aut
7001 a Kuga, R.4 aut
7001 a Palumbo, T. M. S.4 aut
7001 a Docherty, Neil G.u Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för gastrokirurgisk forskning och utbildning,Institute of Clinical Sciences, Department of Gastrosurgical Research and Education4 aut0 (Swepub:gu)xdocme
7001 a le Roux, C. W.4 aut
7102 a Göteborgs universitetb Institutionen för kliniska vetenskaper, Avdelningen för gastrokirurgisk forskning och utbildning4 org
7730 t Jama Surgeryd : American Medical Association (AMA)g 155:8q 155:8x 2168-6254
8564 u https://jamanetwork.com/journals/jamasurgery/articlepdf/2766660/jamasurgery_cohen_2020_oi_200013_1597783616.42894.pdf
8564 8u https://gup.ub.gu.se/publication/296625
8564 8u https://doi.org/10.1001/jamasurg.2020.0420

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