Effect of Gastric Bypass vs Best Medical Treatment on Early-Stage Chronic Kidney Disease in Patients With Type 2 Diabetes and Obesity: A Randomized Clinical Trial

Type Article

Journal Article


R. V. Cohen; T. V. Pereira; C. M. Aboud; T. B. Z. Petry; J. L. Lopes Correa; C. A. Schiavon; C. E. Pompílio; F. N. Q. Pechy; A. C. C. da Costa Silva; F. L. G. de Melo; L. P. Cunha da Silveira; P. P. de Paris Caravatto; H. Halpern; F. L. J. Monteiro; B. da

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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 type 2 diabetes and microalbuminuria were recruited from a single center from April 1, 2013, through March 31, 2016, with a 5-year follow-up, including prespecified intermediate analysis at 24-month follow-up. INTERVENTION: A total of 100 patients with type 2 diabetes, obesity (body mass indexes of 30 to 35 [calculated as weight in kilograms divided by height in meters squared]), and stage G1 to G3 and A2 to A3 CKD (urinary albumin-creatinine ratio [uACR] >30 mg/g and estimated glomerular filtration rate >30 mL/min) were randomized 1:1 to receive best medical treatment (n = 49) or RYGB (n = 51). MAIN OUTCOMES AND MEASURES: The primary outcome was remission of albuminuria (uACR