Comment on: Metabolic surgery improves renal injury independent of weight loss: a meta-analysis

Diabetic kidney disease (DKD) is the leading cause of end-stage renal disease and significantly elevates cardiovascular disease risk [1]. Persons with DKD accounted for 45.4% and 38.2% of incident and prevalent cases of end-stage renal disease in the United States in 2015, respectively [2]. Current management of DKD focuses on control of hyperglycemia and hypertension along with renin-angiotensin-aldosterone system blockade to minimize proteinuria. The most notable recent advances in DKD care include sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 agonists, which reduce glycosylated hemoglobin (A1C), blood pressure, weight, cardiovascular mortality, and nephropathy progression [ 3]. Despite this, existing therapies for DKD slow the rate of renal functional decline rather than reversing it.