2020
DOI: 10.1001/jamasurg.2020.0420
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Abstract: 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 t… Show more

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Cited by 106 publications
(96 citation statements)
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References 37 publications
(46 reference statements)
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“…18 This study demonstrated that at 2-year follow-up in patients with T2DM, class I obesity (body mass index 30-35 kg/m 2 ) and mild-to-moderate DKD (urinary albumin-to-creatinine ratio (uACR) 3-30 mg/ mmol and eGFR >30 mL/min/1.73 m 2 ) microalbuminuria remission occurred in 82% (95% CI 72% to 93%) of patients after RYGB vs 54.6% (95% CI 39% to 70%) of patients after best medical treatment (p=0.006). 18 The potent glucose-lowering effects of Roux-en-Y gastric bypass surgery (RYGB) have been demonstrated to be complimented by improvements in blood pressure which may be mechanistically linked in part to a unique natriuretic effect of the procedure. 19 20 We have previously reported that RYGB effectively reduces albuminuria in the Zucker diabetic fatty (ZDF) rat in conjunction with evidence of improvements in glomerular histology and ultrastructure.…”
Section: Second We Have Recently Collaborated In the Clinical Study mentioning
confidence: 99%
See 1 more Smart Citation
“…18 This study demonstrated that at 2-year follow-up in patients with T2DM, class I obesity (body mass index 30-35 kg/m 2 ) and mild-to-moderate DKD (urinary albumin-to-creatinine ratio (uACR) 3-30 mg/ mmol and eGFR >30 mL/min/1.73 m 2 ) microalbuminuria remission occurred in 82% (95% CI 72% to 93%) of patients after RYGB vs 54.6% (95% CI 39% to 70%) of patients after best medical treatment (p=0.006). 18 The potent glucose-lowering effects of Roux-en-Y gastric bypass surgery (RYGB) have been demonstrated to be complimented by improvements in blood pressure which may be mechanistically linked in part to a unique natriuretic effect of the procedure. 19 20 We have previously reported that RYGB effectively reduces albuminuria in the Zucker diabetic fatty (ZDF) rat in conjunction with evidence of improvements in glomerular histology and ultrastructure.…”
Section: Second We Have Recently Collaborated In the Clinical Study mentioning
confidence: 99%
“…Second, we have recently collaborated in the Clinical Study on Metabolic Surgery Compared to the Best Clinical Treatment in Patients with Type 2 Diabetes Mellitus (MOMS ) RCT (NCT01821508). 18 This study demonstrated that at 2-year follow-up in patients with T2DM, class I obesity (body mass index 30–35 kg/m 2 ) and mild-to-moderate DKD (urinary albumin-to-creatinine ratio (uACR) 3–30 mg/mmol and eGFR >30 mL/min/1.73 m 2 ) microalbuminuria remission occurred in 82% (95% CI 72% to 93%) of patients after RYGB vs 54.6% (95% CI 39% to 70%) of patients after best medical treatment (p=0.006). 18 …”
Section: Introductionmentioning
confidence: 99%
“…Secondly, we have recently collaborated in the Clinical Study on Metabolic Surgery Compared to the Best Clinical Treatment in Patients with Type 2 Diabetes Mellitus ( MOMS ) RCT (NCT01821508). (18). This study demonstrated that at 2 year follow-up in patients with T2DM, Class I obesity (BMI 30-35kg/m 2 ) and mild-moderate DKD (albumin-to-creatinine ratio [uACR] 3-30mg/mmol and eGFR >30mL/min/1.73m 2 ) microalbuminuria remission occurred in 82% (95% CI=72-93%) of patients after RYGB versus 54.6% (95% CI=39-70%) of patients after best medical treatment (P=0.006).…”
Section: Introductionmentioning
confidence: 99%
“…This study demonstrated that at 2 year follow-up in patients with T2DM, Class I obesity (BMI 30-35kg/m 2 ) and mild-moderate DKD (albumin-to-creatinine ratio [uACR] 3-30mg/mmol and eGFR >30mL/min/1.73m 2 ) microalbuminuria remission occurred in 82% (95% CI=72-93%) of patients after RYGB versus 54.6% (95% CI=39-70%) of patients after best medical treatment (P=0.006). (18)…”
Section: Introductionmentioning
confidence: 99%
“…Most studies were small, single center, and observational with limited follow-up. Randomized controlled trials (RCTs) of metabolic surgery in people with kidney disease are limited to early-stage chronic kidney disease (6). Abdominal surgeries are challenging in people on peritoneal dialysis; differences in outcomes of pre-transplant metabolic surgery between dialysis modalities were not explored.…”
mentioning
confidence: 99%