Renoprotective Effects of the Combination of Empagliflozin and Liraglutide Compared With Roux-en-Y Gastric Bypass in Early-Stage Diabetic Kidney Disease: A Post Hoc Analysis of the Microvascular Outcomes after Metabolic Surgery (MOMS) Randomized Controlled Clinical Trial
Abstract
Baseline albuminuria in patients with diabetic kidney disease (DKD) is strongly associated with progressive deterioration in kidney function (1). The remission of microalbuminuria in patients with type 2 diabetes and obesity attenuates the decline in estimated glomerular filtration rate (2). In the Microvascular Outcomes after Metabolic Surgery (MOMS) randomized controlled trial (RCT) (3), we demonstrated that the combination of best medical care and Roux-en-Y gastric bypass (RYGB) surgery is more effective in inducing remission of microalbuminuria than best medical care alone. During the MOMS RCT, type 2 diabetes care guidelines were updated to reflect the potent renoprotective effects of sodium–glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists in people with DKD (4). Thus, the rate of use of the combination of these two agents (Combo) in the study was increased. In this post hoc analysis of the MOMS RCT, our objective was to determine whether the combination of two potent renoprotective medications can match the reductions of albuminuria observed after RYGB. The MOMS RCT protocol has previously been described in detail (3). In brief, 100 patients with CKDG1–3a, A2–3, urine albumin–to–creatinine-ratio (uACR) >30 mg/g, type 2 diabetes, and a BMI of 30–35 kg/m were randomized 1:1 to either best medical care or RYGB. Of the 49 patients, 27 (55%) randomized to best medical treatment received the Combo (empagliflozin 25 mg once daily and…
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Evidence Hub reads this as a secondary / pooled analysis, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 100 participants or records.
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