National Postoperative Bariatric Surgery Outcomes in Patients with Chronic Kidney Disease and End-Stage Kidney Disease

Abstract

Purpose: Obesity is a major risk factor for end-stage kidney disease (ESKD) and is often a barrier to kidney transplantation. However, limited evidence exists evaluating postoperative bariatric surgery outcomes in patients with chronic kidney disease (CKD) and ESKD.

Materials and methods: We performed a retrospective cohort study of patients who underwent bariatric surgery in 2015-2016 using the national Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program dataset. Propensity score matching was used to balance characteristics across patients with CKD and ESKD vs. those without CKD.

Results: There were 323,034 patients without CKD, 1694 patients with CKD, and 925 patients with ESKD who underwent bariatric surgery. Patients with CKD and ESKD had a significantly increased risk of 30-day reoperation (CKD odds ratio [OR] 2.25 95% confidence interval [CI] 1.45-3.51; ESKD OR 3.10, 95% CI 1.72-5.61) and readmission (CKD OR 1.98, 95% CI 1.53-2.56; ESKD OR 2.97, 95% CI 2.05-4.31) compared to patients without CKD; mortality risk was elevated in patients with ESKD (OR 11.59, 95% CI 6.71-20.04) but not in those with CKD (OR 1.00, 95% CI 0.32-3.11). Rates of adverse outcomes were < 15% across all groups. There were 12, 50, and 172 deaths per 1000 person-years among patients without CKD, with CKD, and with ESKD, respectively.

Conclusion: Patients with CKD and ESKD experienced higher risk of postbariatric surgery complications compared to those without kidney disease, although absolute complication rates were low across all groups. CKD and ESKD should not be perceived as contraindications to bariatric surgery.

Keywords: Bariatric surgery; Chronic kidney disease; End-stage renal disease; Obesity; Weight loss surgery.

Conflict of interest statement

Conflicts of Interest

The authors declare that they have no conflicts of interest to disclose.

Figures

Figure 1.. 30-Day Postoperative Risk by Chronic Kidney Disease Statusa

Abbreviations: CKD = chronic kidney disease (pre-dialysis); ESKD = end stage kidney disease (on dialysis). aThe figure represents odds ratios (enclosed circles) with 95% confidence intervals (lines) using multivariable logistic regression of all patients in the cohort (No CKD N=323,034 [green]; CKD N=1,694 [red]; ESKD N=925 [blue]). Models were adjusted for age, sex, race/ethnicity, closest preoperative BMI to surgery, history of hypertension, diabetes, hyperlipidemia, coronary artery disease, pulmonary embolism or deep vein thrombosis, chronic obstructive pulmonary disease, obstructive sleep apnea, gastroesophageal reflux disease, American Society of Anesthesiologists physical status classification, smoking status, functional dependence, and type of bariatric surgery; missing variables were addressed using multiple imputation