Gastric Bypass May Stem Diabetic Kidney Disease More Quickly in Youth Than Adults

By Rob Goodier

November 21, 2019

NEW YORK (Reuters Health) - Gastric bypass appears to lower urine albumin more quickly in diabetic adolescents than in diabetic adults, new research suggests.

The prevalence of elevated urine albumin-to-creatinine ratios dropped from 29% to 6% (P=0.0041) one year after surgery among diabetic adolescents, while the change was not significant in diabetic adults until five years after surgery, according to data presented November 8 at the American Society of Nephrology annual meeting in Washington, D.C.

"Our data suggest earlier resolution of diabetic kidney disease in response to bariatric surgery in youth with T2D compared with adults with T2D. These findings support the indication of bariatric surgery for severely obesity in adolescents with T2D, rather than postponing surgery until adulthood," the study's lead author, Dr. Petter Bjornstad of the University of Colorado in Aurora, told Reuters Health by email.

He and his colleagues compared data from two separate, but related, studies on Roux-en-Y gastric bypass, one with 161 adolescents and the other with 396 adults.

The pre-operative prevalence of elevated urine albumin-to-creatinine ratios was higher in adolescents compared to adults (regardless of their diabetes status). And diabetic adolescents had a higher prevalence of hyperfiltration that was not attenuated by the surgery during the study period.

"Interestingly enough, the hyperfiltration remains which is still pathologic but not clinically as worrisome. I believe practitioners may want to consider gastric bypass as a reno-protective intervention in those obese adolescents who have albuminuria and type 2 diabetes," said Dr. Ladan Golestaneh, a professor of medicine at Albert Einstein College of Medicine in New York City, who was not involved in the research.

"My opinion about this research is that the effects of diabetes on the kidney, once thought to be irreversible, may be reversible quickly in adolescents after weight-loss surgery," he told Reuters Health by email.


Kidney Week 2019.