Bariatric Surgery Outperforms GLP-1 Drugs in Slowing Kidney Disease Progression in Type 2 Diabetics

A recent study conducted by the Cleveland Clinic has revealed that bariatric surgery offers substantial kidney-protective benefits for patients with type 2 diabetes, obesity, and chronic kidney disease (CKD) compared to treatment with GLP-1 receptor agonist medications. Published in Annals of Surgery, the research highlights the potential for bariatric surgery not only to control diabetes and reduce body weight but also to slow the progression of CKD more effectively than pharmacological intervention.

The study tracked 425 adults with type 2 diabetes, obesity, and stage 3 or 4 CKD, assessing the effects of bariatric surgery versus GLP-1 medications. Among the participants, 183 underwent bariatric surgery, while 242 received GLP-1 receptor agonists, such as liraglutide and exenatide, between 2010 and 2017. The follow-up period extended for up to eight years, during which time researchers measured kidney disease progression, the need for dialysis, and mortality rates. The findings were significant: patients who received bariatric surgery had a 60% lower risk of kidney disease progression and a 44% lower risk of developing kidney failure or death compared to those treated with GLP-1 medications alone. Additionally, 22% of the surgical group experienced CKD progression, compared to 45% in the nonsurgical group.

This study matters because chronic kidney disease affects over 1 in 7 adults in the U.S. and can lead to severe outcomes, including renal failure and the need for dialysis. For individuals with type 2 diabetes and obesity—a population at particularly high risk for CKD—effective interventions are crucial. Beyond kidney protection, patients in the bariatric surgery group demonstrated better overall diabetes management, reduced reliance on medication, and sustained weight loss. This suggests that, for patients with advanced CKD, bariatric surgery could be a comprehensive treatment that not only protects kidney function but also enhances metabolic health.

While GLP-1 receptor agonists continue to evolve with new formulations showing promise, the authors suggest bariatric surgery may be an underutilized option for CKD management in clinical practice. Dr. Ali Aminian, director of the Cleveland Clinic’s Bariatric & Metabolic Institute and lead author of the study, emphasized that current CKD management guidelines largely omit bariatric surgery as an option. These findings could support the integration of surgical options in treatment protocols, potentially altering the standard of care for a high-risk patient population. Further studies may explore combining GLP-1 drugs with bariatric surgery to maximize patient outcomes in the future.