Microalbuminuria Clinical Trial
Official title:
Resolution of Microalbuminuria and Dysmetabolism Following Bariatric Surgery: Prospective Study
Favorable effects of bariatric surgery have been demonstrated in particular regarding
increased insulin sensitivity, decreased blood pressure, improved blood lipids and decreased
cardiovascular risk. After surgery, weight loss also leads to improvement of the chronic
inflammatory state related to obesity, a strong predictor of the metabolic status. Although
obese patients are often affected with type 2 diabetes and hypertension, both related to
renal impairment, the existence of a distinct mechanism by which obesity would cause chronic
renal insufficiency has been suggested. The mechanisms underlying obesity-related
nephropathy have been proposed to involve hyperfiltration, expansion of mesangial cells,
hyperperfusion leading to proteinuria and glomerulosclerosis, as noted in obese dogs. In
humans, improvements in renal function may be observed following bariatric surgery, although
some reported a possibility of increased nephrolithiases. Whether biliopancreatic diversion
and gastrectomy alone have similar effects is uncertain. More prospective studies are needed
to assess the impact of all types of weight loss surgery to reverse chronic renal
insufficiency.
The objective of this study is to document changes in microalbuminuria and metabolic
parameters in patients with altered renal function undergoing bariatric surgery. Patients
enrolled in the study will show renal function impairment as demonstrated by
albumin/creatinine ratio alterations in 2 out of 3 measurements taking place before surgery.
We will perform a prospective study of renal function markers (albumin/creatinine ratio) and
metabolic parameters (blood lipids, glucose, insulin, inflammatory markers) before and 6,
12, 24 months after surgery in patients with microalbuminuria at study onset
(albumin/creatinine ratio 2.0-20.0 mg/mmol in men and 2.8-28.0 mg/mmol in women). Data will
be analysed with repeated measures analyses in both subgroup. Thereafter, a linear
regression model will be created to adjust for potentially confounding factors such as
hypertension and diabetes. We hypothesize that patients with severe obesity and altered
renal function, whether they are diabetic or not, have improved microalbuminuria and
metabolic parameters following biliopancreatic diversion with sleeve gastrectomy or sleeve
gastrectomy alone. The extent of renal function recovery will correlate directly with
metabolic improvements.
n/a
Observational Model: Cohort, Time Perspective: Prospective
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