Please select the eligibility criteria that correspond to the clinical trial below.
Title: The Effect of Weight Loss Surgery on Preservation of Kidney Function and Cardiovascular Disease Risk Factors in Obese Patients With Stages 3-4 Chronic Kidney Disease: a Randomised Controlled Trial
Brief Summary: Weight loss surgery is the most effective weight loss treatment available, but the direct effect on chronic kidney disease is less widely understood. Early research shows some improvement in kidney function may occur and candidacy for kidney transplantation can be improved with weight loss following surgery. To date, no randomised controlled trial has been performed to examine the effect of weight loss surgery on the progression of chronic kidney disease.

This randomised trial will allocate patients to either lifestyle modification with diet, exercise and pharmacotherapy, or weight loss surgery to remove two thirds of the stomach using the laparoscopic sleeve gastrectomy procedure. This study aims to evaluate weight loss surgery vs lifestyle modification in patients with chronic kidney disease with estimated kidney function of 20-60% and morbid obesity (BMI 35-45) in terms of kidney function, cardiovascular disease risk factors and all-cause mortality.


Options:
A: Inclusion Criteria:

* Biopsy-proven IgA nephropathy
* body mass index more than 23 Kg/m2
* 24 hours urine protein more than 1 g
* estimated GFR more than 20 ml/min

Exclusion Criteria:

* pregnancy and lactation
* rapidly renal function decline
* crescent formation in renal biopsy more than 10%
B: Inclusion Criteria:

* Stages 3-4 CKD patients (GFR 20-60 mL/min)
* Male or female
* BMI 35-45 kg/m2
* Aged \>18 years
* Previously attempted weight loss
* Fit or anesthesia and surgery
* Written informed consent

Exclusion Criteria:

* Pregnancy
* History of chronic liver disease
* Previous gastric surgery or large hiatus hernia
* Previous bariatric surgery
* Psychiatric illness, including anxiety, mood and untreated eating disorders
* Malnutrition (assessed by subjective global assessment)
* Infection or course of antibiotics within the last month
* Unwilling to consider surgical treatment
* Previous kidney transplant
C: Inclusion Criteria:

1. Male or female patient, at least 18 years of age with known type 2 diabetes, diagnosis of type 2 diabetes should have been made at \> 30 years of age (if diabetes developed at a younger age, C-peptide level may be obtained to confirm diagnosis)
2. The average of two eGFR values collected during screening must be within 20 - 45 mL/min/1.73m2, inclusive
3. Patient must be receiving an angiotensin converting enzyme (ACE) inhibitor and/or an angiotensin II receptor blocker (ARB) for at least 3 months prior to screening, where the dose of the ACE inhibitor or the ARB is considered appropriate for that patient, and has been stable and maintained on that dose for at least 8 weeks prior to the Randomization visit
4. For male and female subjects, agreement to use effective contraception during the entire study period and for at least 2 months after the last dose of study drug, unless documentation of infertility exists
5. Women of child-bearing potential, she must have a negative serum pregnancy test at screening and a negative urine pregnancy test confirmed within 72 hours prior to the first dose of study medication
6. Patient is willing and able to cooperate with all aspects of the protocol
7. Patient is willing and able to give written informed consent for study participation.

Exclusion Criteria:

1. Type 1 (insulin-dependent; juvenile onset) diabetes, or any history of diabetic ketoacidosis
2. Patients with known non-diabetic renal disease or patients with a history of a renal transplant
3. Patients with a Hemoglobin A1c \>10% collected at the Screening A visit
4. Cardiovascular disease as follows: Unstable angina pectoris within 3 months prior to study randomization; Myocardial infarction, coronary artery bypass graft surgery, or percutaneous transluminal coronary angioplasty/stent within 3 months prior to study randomization; Transient ischemic attack within 3 months of study randomization; Cerebrovascular accident within 3 months of study randomization; Obstructive valvular heart disease or hypertrophic cardiomyopathy; Diagnosis of Class III or IV congestive heart failure at any time
5. Systolic blood pressure (BP) \>160 mmHg and diastolic blood pressure \> 90 determined by the average of three seated readings taken at least 5 minutes apart, at each of two time-points at least 5 days apart during the screening period
6. QTc Fredericia interval \> 450 milliseconds determined by the average of values reported by a central reader from three ECGs taken at the Screening A visit. Each of the three ECGs will be obtained using only equipment provided by the Sponsor, and the ECGs shall be obtained at least ten minutes apart.
7. Second or third degree atrioventricular block not successfully treated with a pacemaker
8. Need for chronic (\>2 weeks) immunosuppressive therapy, or need for corticosteroids (excluding intraarticular injections,inhaled or nasal steroids) within 3 months of study randomization
9. Evidence of hepatic or biliary dysfunction including total bilirubin \>1.0 mg/dL (\>17 micromol/L), aspartate aminotransferase (AST) or alanine aminotransferase (ALT) \> upper limit of normal (ULN), or alkaline phosphatase \>2.0 ULN on ANY screening lab
10. If female, patient is pregnant, nursing or planning a pregnancy
11. Patient has any concurrent clinical conditions that in the judgment of the investigator could either potentially pose a health risk to the patient while involved in the study or could potentially influence the study outcome
12. Patient has known hypersensitivity to any component of the study drug
13. Patient has undergone a diagnostic or interventional procedure requiring a contrast agent within 30 days prior to randomization
14. Change or dose adjustment in any of the following medications within 8 weeks prior to randomization into the study or anticipated change in dose within 30 days following randomization into the study: ACE inhibitors, angiotensin II receptor blockers.
15. Change or dose adjustment of any other anti-hypertensive, and other anti-diabetic medications within 8 weeks prior to randomization or anticipated change in dose within 30 days following randomization into the study
16. Patient has a current history of drug or alcohol abuse as per the investigator's assessment
17. Patient has participated in another investigational study within 30 days prior to randomization into the study or would concomitantly participate in such a study, or has previously participated in a trial involving bardoxolone methyl.
18. Patient is unable to communicate or cooperate with the investigator due to language problems, poor mental development or impaired cerebral function
19. Patient is unable or unwilling to utilize the daily phone diary to track the date and time they take their study medication
20. Patients on any of the following known hepatotoxic agents: Antioxidant N-acetly-cysteine (Mucomyst, Acetadote, Fluimucil, Parvolex), Niacin (nicotinic acid), Dantrium (dantrolene), Naizide (isoniazid), Normodyne (labetalol), Cylert (pemoline), Felbatol (felbamate), Zyflo (zileuton), Tasmar (tolcapone), or Trovan (trovafloxacin). Patients must have been off the aforementioned medications for a minimum of two weeks prior to randomization
21. Patients who are unable or unwilling to discontinue fenofibrate (Antara, Fenoglide, Lipofen, Lofibra, TriCor, Triglide) during the first three months of study treatment. Patients must have been off fenofibrate for a minimum of two weeks prior to randomization
22. Patients who require more than occasional (once or twice weekly) use of non-steroidal anti-inflammatory agents (NSAIDS)
23. Patients with a history of neoplastic disease (except basal or squamous cell carcinoma of the skin) within 5 years prior to the randomization visit;
24. Patients who have had prior dialysis within three months of randomization and/or have not maintained a stable level of kidney function within three months of randomization per Investigator assessment
D: Inclusion Criteria:

* Stage III-IV CKD measured by the MDRD equation with eGFR 15-60 ml/min/1.73m2;
* Age 18-75 years;
* BMI ≥ 25;
* Life expectancy ≥ 1 year;
* Ability to understand and provide informed consent.

Exclusion Criteria:

* Any acute inflammatory condition (including chronic infection requiring treatment, and collagen vascular disease including active gout);
* Pregnancy;
* Taking high-dose anti-oxidants (Vitamin E or C);
* Chronic use of anti-inflammatory medication except low dose (\< 10mg/d) prednisone and aspirin (\< 100 mg/day);
* Significant cardiac or vascular disease (symptomatic disease or CV event including congestive heart failure within 6 months);
* Significant occlusive atherosclerotic disease or ischemic disease (on non-invasive or invasive diagnostic procedures);
* Significant physical immobility or disabilities (joint replacement, muscular disorders);
* Type I diabetes mellitus, or Type II requiring insulin therapy;
* History of poor adherence to medical regimen;
* Those subjects who have a diagnosis of atrial fibrillation or a pacemaker will be allowed in the study but will not undergo Arterial Tonometry (PWV) studies.

Answer: B