Five-year kidney outcomes of bariatric surgery differ in severely obese adolescents and adults with and without type 2 diabetes.,Kidney International

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Five-year kidney outcomes of bariatric surgery differ in severely obese adolescents and adults with and without type 2 diabetes.
Kidney International ( IF 14.8 ) Pub Date : 2020-02-03 , DOI: 10.1016/j.kint.2020.01.016
Petter Bjornstad ₁ , Edward Nehus ₂ , Todd Jenkins ₂ , Mark Mitsnefes ₂ , Marva Moxey-Mims ₃ , John B Dixon ₄ , Thomas H Inge ₁

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Bariatric surgery improves markers of kidney health in severe obesity, yet it is unclear if kidney disease outcomes differ according to age at surgery. Therefore, we examined health effects of Roux-en-Y gastric bypass between 161 adolescents and 396 adults participating in two related but distinct studies. Primary outcomes were elevated urine albumin-to-creatinine ratio (UACR) of 30 mg/g or more and hyperfiltration (an estimated glomerular filtration rate of 135 ml/min/1.73m2 or more). Analyses were stratified by the presence of pre-operative type 2 diabetes. Adolescents with pre-operative type 2 diabetes had a significantly increased prevalence of elevated UACR prior to surgery compared to adults (22.5 vs. 9.0%). Resolution of elevated UACR following surgery differed between adolescents and adults with type 2 diabetes, with adolescents experiencing a significantly earlier improvement following surgery. Adolescents without pre-operative type 2 diabetes demonstrated a significantly increased prevalence of UACR prior to surgery compared to adults (9.4 vs. 4.5%), with no improvement occurring in either group post-operatively. Adolescents with pre-operative type 2 diabetes had a significantly increased prevalence of hyperfiltration that remained throughout the study period, whereas hyperfiltration prevalence was similar among those without type 2 diabetes. Thus, adolescents with pre-operative type 2 diabetes experienced earlier attenuation of elevated UACR compared to adults with pre-operative type 2 diabetes in response to gastric bypass.

中文翻译：

在严重肥胖的青少年和患有和不患有2型糖尿病的成年人中，减肥手术的五年肾脏预后不同。

减肥手术可改善严重肥胖症患者肾脏健康的指标，但尚不清楚肾脏疾病的结局是否随手术年龄而异。因此，我们研究了参加两项相关但截然不同的研究的161名青少年和396名成年人之间的Roux-en-Y胃旁路手术对健康的影响。主要结局是尿白蛋白/肌酐比值（UACR）升高至30 mg / g或更高，并出现超滤（估计的肾小球滤过率达135 ml / min / 1.73m2或更高）。术前2型糖尿病的存在对研究进行了分层。与成人相比，术前2型糖尿病的青少年手术前UACR升高的患病率显着增加（22.5比9.0％）。青少年和成人2型糖尿病患者手术后UACR升高的解决方案有所不同，青少年手术后的病情明显好转。与成人相比，无术前2型糖尿病的青少年手术前UACR的患病率显着增加（9.4比4.5％），两组术后均无改善。患有术前2型糖尿病的青少年在整个研究期间的高滤过率患病率均显着增加，而没有2型糖尿病的青少年的高滤过率患病率相似。因此，与术前2型糖尿病的成年人相比，术前2型糖尿病的青少年经历了UACR升高的早期缓解。与成人相比，无术前2型糖尿病的青少年手术前UACR的患病率显着增加（9.4比4.5％），两组术后均无改善。患有术前2型糖尿病的青少年在整个研究期间的高滤过率患病率均显着增加，而没有2型糖尿病的青少年的高滤过率患病率相似。因此，与术前2型糖尿病的成年人相比，术前2型糖尿病的青少年经历了UACR升高的早期缓解。与成人相比，无术前2型糖尿病的青少年手术前UACR的患病率显着增加（9.4比4.5％），两组术后均无改善。患有术前2型糖尿病的青少年在整个研究期间的高滤过率患病率均显着增加，而没有2型糖尿病的青少年的高滤过率患病率相似。因此，与术前2型糖尿病的成年人相比，术前2型糖尿病的青少年经历了UACR升高的早期缓解。患有术前2型糖尿病的青少年在整个研究期间的高滤过率患病率均显着增加，而没有2型糖尿病的青少年的高滤过率患病率相似。因此，与术前2型糖尿病的成年人相比，术前2型糖尿病的青少年经历了UACR升高的早期缓解。患有术前2型糖尿病的青少年在整个研究期间的高滤过率患病率均显着增加，而没有2型糖尿病的青少年的高滤过率患病率相似。因此，与术前2型糖尿病的成年人相比，术前2型糖尿病的青少年经历了UACR升高的早期缓解。

更新日期：2020-02-03

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