Improvement in Renal Function in Participants in the First UK National Health Service (NHS) EndoBarrier Service for Uncontrolled Diabesity

Aims: EndoBarrier, a 60cm proximal intestinal liner, endoscopically implanted for up to one-year, reduces weight and HbA1c. As the risk of progressive chronic kidney disease (CKD) is increased by high BMI, we assessed impact EndoBarrier on renal function. Methods: Between October 2014 November 2017 EndoBarriers in 62 patients with sub-optimally controlled diabesity our NHS service; 2018 all were explanted. Clinical laboratory outcomes, including routinely performed function testing serum creatinine MDRD eGFR, collected registry Results: In 61 (aged 51.4±7.2 years, 54.1% male, 57.4% europid, diabetes duration 12.0 (8.0-19.5) insulin-treated, BMI 41.9±7.4 kg/m2) implant explant data, fell 15.9±8.5 kg from 122.6±27.9 106.7±28.9 (p<0.001), 36.2±7.6 kg/m2 (p<0.001) systolic blood pressure (BP) 138.5±15.0 125.8±14.6 mmHg mean±SD. HbA1c 23.7±21.4 mmol/mol 80.2±22.5 56.5±11.5 mmol/mol(p<0.001), cholesterol 4.7±1.4 3.9±0.9 mmol/L alanine-aminotransferase (ALT – marker liver fat) 33.2±19.8 19.5±11.4 U/L (p<0.001). 35 insulin-treated median (IQR) insulin dose reduced 100 (54-140) 40 (0-70) units 10/35 (28.6%) discontinuing insulin. With regard function, mean±SD improved 5.5±15.4 μmol/L 91.7±47.7 86.2±45.7 (p=0.007) estimated-Glomerular-Filtration-Rate (abbreviated equation) 5.8±10.7 ml/min/1.73m2 84.3±25.2 90.1±26.4 Five had raised (>133 μmol/L) prior Endobarrier; after implantation four these two normalised. The impairment who sustained improvement large loss (19.3-34.4 kg), patient without only 6.6 loss. Conclusion: well as previously documented improvements weight, HbA1c, BP, ALT cholesterol, was associated These observational findings warrant further investigation through prospective study such bariatric interventions CKD.