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Gastric Bypass May Be The Best Medication For Lowering Albuminuria In Early Kidney Disease

Roux-en-Y gastric bypass (RYGB) was more effective than best medical treatment in achieving albuminuria remission in patients with type 2 diabetes and obesity in an intermediate analysis of a randomized controlled trial.

“This is a new treatment paradigm to slow or arrest chronic kidney progression in patients with diabetes and obesity,” Dr. Ricardo Vitor Cohen of Oswaldo Cruz German Hospital in Sao Paulo, Brazil, told Reuters Health by email. “It can lead to practice-change.”

Coauthor Dr. Carel le Roux from University College Dublin, in Ireland, added, “This will have far-reaching implications not only to alleviate the suffering of patients or potentially preventing early death, but it will also reduce the direct healthcare cost for patients themselves or for private and public payers, because end-stage kidney disease treatment is one of the most expensive treatments any health system undertakes.”

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Managing Pain Expectations is The Key to Enhanced Recovery

Planning for reduced use of opioids in pain management involves identifying appropriate patients and managing their expectations, according to Timothy E. Miller, MB, ChB, FRCA, of Duke University, Durham, N.C., who is president of the American Society for Enhanced Recovery.

Multimodal analgesia plans can be a beneficial part of enhanced recovery and may reduce or eliminate the need for opioids in some patients, he said in a presentation at the virtual Annual Minimally Invasive Surgery Symposium sponsored by Global Academy for Medical Education.

Dr. Miller shared a treatment algorithm for achieving optimal analgesia in patients after colorectal surgery that combines intravenous or oral analgesia with local anesthetics and additional nonopioid options. The algorithm involves choosing NSAIDs, acetaminophen, or gabapentin for IV/oral use. In addition, options for local anesthetic include with a choice of single-shot transversus abdominis plane (TAP) block.

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