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