PMID- 32152136
OWN - NLM
STAT- MEDLINE
DCOM- 20210226
LR  - 20210226
IS  - 1935-5548 (Electronic)
IS  - 0149-5992 (Linking)
VI  - 43
IP  - 6
DP  - 2020 Jun
TI  - Renal and Cardiovascular Outcomes After Weight Loss From Gastric Bypass Surgery 
      in Type 2 Diabetes: Cardiorenal Risk Reductions Exceed Atherosclerotic Benefits.
PG  - 1276-1284
LID - 10.2337/dc19-1703 [doi]
AB  - 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/m(2), 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 m(2). 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.
CI  - (c) 2020 by the American Diabetes Association.
FAU - Liakopoulos, Vasileios
AU  - Liakopoulos V
AUID- ORCID: 0000-0003-0201-0889
AD  - Department of Molecular and Clinical Medicine, University of Gothenburg, 
      Gothenburg, Sweden vasileios.liakopoulos@vgregion.se.
AD  - Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
FAU - Franzen, Stefan
AU  - Franzen S
AD  - National Diabetes Register, Center of Registers, Gothenburg, Sweden.
AD  - Health Metrics Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 
      Sweden.
FAU - Svensson, Ann-Marie
AU  - Svensson AM
AD  - Department of Molecular and Clinical Medicine, University of Gothenburg, 
      Gothenburg, Sweden.
AD  - National Diabetes Register, Center of Registers, Gothenburg, Sweden.
FAU - Sattar, Naveed
AU  - Sattar N
AUID- ORCID: 0000-0002-1604-2593
AD  - The Institute of Cardiovascular and Medical Sciences, University of Glasgow, 
      Glasgow, U.K.
FAU - Miftaraj, Mervete
AU  - Miftaraj M
AD  - National Diabetes Register, Center of Registers, Gothenburg, Sweden.
FAU - Bjorck, Staffan
AU  - Bjorck S
AD  - National Diabetes Register, Center of Registers, Gothenburg, Sweden.
FAU - Ottosson, Johan
AU  - Ottosson J
AD  - Department of Surgery, Faculty of Medicine and Health, Orebro University, Orebro, 
      Sweden.
FAU - Naslund, Ingmar
AU  - Naslund I
AD  - Department of Surgery, Faculty of Medicine and Health, Orebro University, Orebro, 
      Sweden.
FAU - Gudbjornsdottir, Soffia
AU  - Gudbjornsdottir S
AD  - Department of Molecular and Clinical Medicine, University of Gothenburg, 
      Gothenburg, Sweden.
AD  - National Diabetes Register, Center of Registers, Gothenburg, Sweden.
FAU - Eliasson, Bjorn
AU  - Eliasson B
AD  - Department of Molecular and Clinical Medicine, University of Gothenburg, 
      Gothenburg, Sweden.
AD  - Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20200309
PL  - United States
TA  - Diabetes Care
JT  - Diabetes care
JID - 7805975
SB  - IM
CIN - Diabetes Care. 2020 Jun;43(6):1175-1177. PMID: 32434895
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Atherosclerosis/epidemiology/etiology
MH  - Cardiovascular Diseases/epidemiology/etiology
MH  - Cardiovascular System/*physiopathology
MH  - Cohort Studies
MH  - Diabetes Complications/epidemiology/etiology
MH  - Diabetes Mellitus, Type 2/complications/epidemiology/physiopathology/*surgery
MH  - Female
MH  - *Gastric Bypass
MH  - Glomerular Filtration Rate
MH  - Humans
MH  - Kidney/*physiopathology
MH  - Kidney Diseases/epidemiology/etiology
MH  - Male
MH  - Middle Aged
MH  - Obesity/complications/epidemiology/physiopathology/*surgery
MH  - Risk Assessment
MH  - Risk Reduction Behavior
MH  - Sweden/epidemiology
MH  - Treatment Outcome
MH  - Weight Loss/*physiology
MH  - Young Adult
EDAT- 2020/03/11 06:00
MHDA- 2021/02/27 06:00
CRDT- 2020/03/11 06:00
PHST- 2019/08/24 00:00 [received]
PHST- 2020/01/22 00:00 [accepted]
PHST- 2020/03/11 06:00 [pubmed]
PHST- 2021/02/27 06:00 [medline]
PHST- 2020/03/11 06:00 [entrez]
AID - dc19-1703 [pii]
AID - 10.2337/dc19-1703 [doi]
PST - ppublish
SO  - Diabetes Care. 2020 Jun;43(6):1276-1284. doi: 10.2337/dc19-1703. Epub 2020 Mar 9.