Metabolic Surgery to Treat Obesity in Diabetic Kidney Disease, Chronic Kidney Disease, and End-Stage Kidney Disease; What Are the Unanswered Questions?

Files in This Item:
 File SizeFormat
Downloadfendo-11-00289.pdf3.15 MBAdobe PDF
Title: Metabolic Surgery to Treat Obesity in Diabetic Kidney Disease, Chronic Kidney Disease, and End-Stage Kidney Disease; What Are the Unanswered Questions?
Authors: Martin, William P.White, JamesLópez-Hernández, Francisco J.Docherty, Neil G.le Roux, Carel W.
Permanent link: http://hdl.handle.net/10197/12672
Date: 17-Aug-2020
Online since: 2021-11-29T11:20:33Z
Abstract: Obesity is a major factor in contemporary clinical practice in nephrology. Obesity accelerates the progression of both diabetic and non-diabetic chronic kidney disease and, in renal transplantation, both recipient and donor obesity increase the risk of allograft complications. Obesity is thus a major driver of renal disease progression and a barrier to deceased and living donor kidney transplantation. Large observational studies have highlighted that metabolic surgery reduces the incidence of albuminuria, slows chronic kidney disease progression, and reduces the incidence of end-stage kidney disease over extended follow-up in people with and without type 2 diabetes. The surgical treatment of obesity and its metabolic sequelae has therefore the potential to improve management of diabetic and non-diabetic chronic kidney disease and aid in the slowing of renal decline toward end-stage kidney disease. In the context of patients with end-stage kidney disease, although complications of metabolic surgery are higher, absolute event rates are low and it remains a safe intervention in this population. Pre-transplant metabolic surgery increases access to kidney transplantation in people with obesity and end-stage kidney disease. Metabolic surgery also improves management of metabolic complications post-kidney transplantation, including new-onset diabetes. Procedure selection may be critical to mitigate the risks of oxalate nephropathy and disruption to immunosuppressant pharmacokinetics. Metabolic surgery may also have a role in the treatment of donor obesity, which could increase the living kidney donor pool with potential downstream impact on kidney paired exchange programmes. The present paper provides a comprehensive coverage of the literature concerning renal outcomes in clinical studies of metabolic surgery and integrates findings from relevant mechanistic pre-clinical studies. In so doing the key unanswered questions for the field are brought to the fore for discussion.
Funding Details: Health Research Board
Health Service Executive
Science Foundation Ireland
Wellcome Trust
Funding Details: Swedish Medical Research Council
European Foundation for the Study of Diabetes
Type of material: Journal Article
Publisher: Frontiers
Journal: Frontiers in Endocrinology
Volume: 11
Copyright (published version): 2020 the Authors
Keywords: Renal transplantationType 2 diabetes mellitusDiabetic kidney diseaseChronic kidney diseaseEnd-stage kidney diseaseKidney transplantationDialysisLaproscopic sleeve gastrectomyY-gastric bypassIntensive medical therapy
DOI: 10.3389/fendo.2020.00289
Language: en
Status of Item: Peer reviewed
ISSN: 1664-2392
This item is made available under a Creative Commons License: https://creativecommons.org/licenses/by/3.0/ie/
Appears in Collections:Conway Institute Research Collection
Medicine Research Collection

Show full item record

Page view(s)

276
Last Week
14
Last month
74
checked on Jan 27, 2022

Download(s)

9
checked on Jan 27, 2022

Google ScholarTM

Check

Altmetric


If you are a publisher or author and have copyright concerns for any item, please email research.repository@ucd.ie and the item will be withdrawn immediately. The author or person responsible for depositing the article will be contacted within one business day.