A recent study conducted at the Cleveland Clinic found that individuals with obesity, diabetes, and chronic kidney disease who underwent bariatric surgery were less likely to see their kidney disease progress compared to those treated with GLP-1 drugs. Chronic kidney disease often stems from type 2 diabetes, which is linked to obesity and a leading cause of mortality from diabetes. Bariatric surgery, such as gastric sleeve surgery, not only reduces the size of the stomach, but also triggers metabolic changes that decrease hunger, aiding in weight loss and potentially slowing the progression of kidney disease.
The study involved 425 participants who were followed for an average of 5.8 years. Of these, 183 received bariatric surgery and 242 were treated with GLP-1 diabetes drugs that promote weight loss. Individuals who underwent surgery had a 60% lower risk of kidney impairment progression and a 44% lower risk of kidney failure or death compared to those on medication. Bariatric surgery involves reducing the stomach’s size, which leads to enhanced satiety and metabolic alterations that curb hunger and promote weight loss. These changes can alleviate obesity, a condition that exacerbates kidney disease and diabetes.
Obesity, a condition that burdens all organs, poses a heightened risk for type 2 diabetes, which can negatively impact kidney health, especially with poor blood sugar control. While diabetes is not a definitive precursor to chronic kidney disease, additional factors such as hereditary or congenital issues can contribute. While bariatric surgery may not be the primary choice for individuals with obesity and kidney disease, it is increasingly considered for those with severe obesity, particularly if they also have diabetes. Surgical eligibility often involves specific requirements set by insurance companies, including body mass index within a certain range and absence of other medical conditions.
GLP-1 drugs, although effective in controlling diabetes and aiding weight management, may not induce the same metabolic alterations as bariatric surgery. However, they can still positively impact kidney health without the need for surgery. The procedure’s ability to alter metabolism is grounded in its reduction of stomach hormones, such as ghrelin, which regulate hunger. By bypassing certain digestion-stimulating areas, surgery can modify an individual’s metabolism and improve overall health, safeguarding the kidneys from diabetes-related damage and other detrimental factors.
Apart from the benefits observed in chronic kidney disease in the study, weight loss surgery has demonstrated long-lasting effectiveness compared to medications. While a BMI of 40 indicates significant overweight, success in weight loss surgery is defined as losing at least half of this weight and maintaining it for five years. The durability of diet and exercise alone is low, with a success rate of 2-5%, whereas surgery boasts a success rate of around 80% in the long term. Although the long-term success of GLP-1 drugs is still under examination, they are anticipated to provide better outcomes than diet and exercise, albeit not as robust as bariatric surgery.
