Can metabolic surgery help save kidneys in a 36-year-old?

Question

Hello doctor,

I am 36 years old, diabetic since childhood, and my nephrologist says my kidneys are starting to fail because of my uncontrolled blood sugar. My BMI (body mass index) is 41, and I have tried everything to lose weight. My endocrinologist suggested metabolic surgery as my best chance to save my kidneys. I am terrified of surgery, but more scared of dialysis. Would the gastric bypass or sleeve be better for someone with kidney problems? How soon after surgery might I see improvement in my diabetes? I have read stories of people getting off insulin completely. Is that realistic for a long-term diabetic like me?

Please suggest.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

As you mentioned, she is 36 years old with a BMI (body mass index) of 41, which falls into class 3 obesity, with uncontrolled diabetes, so you are a candidate to have a bariatric or metabolic surgery.

Normal BMI 18.5 to 24.9.
Overweight 25 to 29.9.
Class 1 obesity 30 to 34.9.
Class 2 obesity 35 to 39.9.
Class 3 obesity > 40.

In such cases, not opting for surgery, continued progression of diabetes, cardiovascular disease, and kidney damage can outweigh the risks of surgery itself, especially if medications and lifestyle changes have not been effective. Metabolic surgery can help to improve both blood sugar and hypertension, depending on the type of surgical procedure, with around 60 to 70% induce remission for diabetes and HTN (hypertension).

There are different types of bariatric surgeries.

1. Sleeve gastrectomy (upto 80% of stomach is removed) is very effective for weight loss and diabetes improvement.

2. Roux-en-y- gastric bypass (RYGB) - It creates a small stomach pouch and reroutes the small intestine to bypass part of the stomach and duodenum. It is most effective for type 2 diabetes remission.

3. Mini gastric bypass (one anastomosis bypass) - This is a shorter surgery with fewer complications. It is effective for weight loss and diabetes.

4. Adjustable gastric banding - It has a high rate of long-term complications and reoperations.

5. Biliopancreatic diversion with duodenal switch (BPD-DS) - It has the highest weight loss and diabetes remission rates. It has a high risk of malnutrition and requires lifelong strict vitamin and protein supplementation.

The main difference between sleeve gastrectomy and Roux-en-Y gastric bypass is :

1. Sleeve gastrectomy: About 75 to 80% of the stomach is removed, leaving a narrow gastric "sleeve." There is no intestinal bypass; only restrictive. It reduces stomach volume and decreases ghrelin (hunger hormone). There is minimal malabsorption with a lower risk of deficiencies. The weight loss is around 60 to 70%.

2. Roux-en-Y gastric bypass (RYGB): A small stomach pouch is created and connected directly to the jejunum. It bypasses the duodenum and part of the jejunum. It is both restrictive and malabsorptive. It reduces intake and nutrient absorption and also alters gut hormones. There is significant malabsorption with a higher risk of deficiencies in iron, B12, and calcium. Weight loss is around 65 to 80%, slightly more than sleeve gastrectomy.

The complications include bleeding, infections, and anastomosis leakage. The hospital stay is one to three days. You can do a full activity within four to six weeks. You will follow a structured plan starting with liquids, then soft foods, and then regular meals over a few weeks. Most patients lose 60 to 80% of excess weight and maintain long-term improvements in blood sugar and pressure.

You will need to commit to having regular follow-up, nutritional counseling, and possibly vitamin supplements for life. For more information, you can consult a bariatric surgeon, who can guide you the best option for you.

I hope this answers your query.

Let me know if I need to assist you further.

Thank you.