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 have their kidney disease progress compared to those who were treated with GLP-1 drugs. Chronic kidney disease often develops as a complication of type 2 diabetes, particularly in cases where obesity is also present, and is a leading cause of mortality among individuals with diabetes. Bariatric surgery not only reduces the size of the stomach but also induces metabolic changes that decrease hunger, making it an effective intervention for individuals struggling with obesity and chronic kidney disease.
The study included 425 participants who were followed for a median of 5.8 years. Of these, 183 received bariatric surgery while 242 were treated with GLP-1 drugs. The findings indicated that individuals who underwent bariatric surgery had a lower risk of kidney impairment progression and kidney failure or death compared to those treated with GLP-1 drugs. Bariatric surgery, such as gastric sleeve surgery, involves reducing the size of the stomach by approximately 80%, leading to reduced food intake and metabolic changes that decrease hunger. These changes contribute to resolving obesity, a risk factor for both kidney disease and diabetes.
Obesity is a condition that places stress on all of the body’s organs and increases the risk of developing type 2 diabetes. Poor blood sugar control in diabetes can also negatively impact kidney health, though chronic kidney disease can occur independently of diabetes as well. While bariatric surgery may not be the initial choice for individuals with obesity and kidney disease, it is becoming more common for those with severe obesity, especially when accompanied by diabetes. However, qualifying requirements for insurance coverage in the United States typically include a BMI between 35 and 40 with no additional medical conditions.
GLP-1 drugs for diabetes may help control blood sugar levels and aid in weight loss, benefiting the kidneys without the need for surgery. These medications may provide positive metabolic changes but are not as effective as bariatric surgery in inducing sustained weight loss. Hormones produced in the stomach, such as ghrelin, play a role in hunger sensation, and surgical interventions like the gastric sleeve or bypass can alter hormone production to reduce hunger cravings, leading to weight loss and metabolic improvements. Studies have shown that weight loss surgery is more durable than medications for sustained weight loss.
Long-term success rates with diet and exercise alone are low, with only 2-5% of individuals able to maintain weight loss over time. In contrast, bariatric surgery has been associated with long-term success rates of approximately 80% in maintaining weight loss. While the durability of weight loss with GLP-1 drugs is not yet well-established, they are likely to be more effective than diet and exercise but not as potent as surgery. Overall, bariatric surgery offers benefits beyond just weight loss, including improvements in metabolic health, diabetes management, and kidney disease outcomes.
