Skip to main content
SpringerLink
Log in

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

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Franceschini N, Gouskova NA, Reiner AP, et al. Adiposity patterns and the risk for ESRD in postmenopausal women. Clin J Am Soc Nephrol. 2015;10(2):241–50.

    Article  PubMed  Google Scholar 

  2. Kramer H, Gutierrez OM, Judd SE, et al. Waist circumference, body mass index, and ESRD in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study. Am J Kidney Dis. 2016;67(1):62–9.

    Article  PubMed  Google Scholar 

  3. Guh DP, Zhang W, Bansback N, et al. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health. 2009;9:88.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Vazquez G, Duval S, Jacobs Jr DR, et al. Comparison of body mass index, waist circumference, and waist/hip ratio in predicting incident diabetes: a meta-analysis. Epidemiol Rev. 2007;29:115–28.

    Article  PubMed  Google Scholar 

  5. Wormser D, Kaptoge S, Di Angelantonio E, et al. Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: collaborative analysis of 58 prospective studies. Lancet. 2011;377(9771):1085–95.

    Article  PubMed  Google Scholar 

  6. Hsu CY, McCulloch CE, Iribarren C, et al. Body mass index and risk for end-stage renal disease. Ann Intern Med. 2006;144(1):21–8.

    Article  PubMed  Google Scholar 

  7. Cohen JB, Cohen DL. Cardiovascular and renal effects of weight reduction in obesity and the metabolic syndrome. Curr Hypertens Rep. 2015;17(5):34.

    Article  CAS  PubMed  Google Scholar 

  8. Cohen JB. Hypertension in obesity and the impact of weight loss. Curr Cardiol Rep. 2017;19(10):98.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes—5-year outcomes. N Engl J Med. 2017;376(7):641–51.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Sjostrom L, Peltonen M, Jacobson P, et al. Bariatric surgery and long-term cardiovascular events. JAMA. 2012;307(1):56–65.

    Article  PubMed  Google Scholar 

  11. Navaneethan SD, Yehnert H, Moustarah F, et al. Weight loss interventions in chronic kidney disease: a systematic review and meta-analysis. Clin J Am Soc Nephrol. 2009;4(10):1565–74.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Friedman AN, Wahed AS, Wang J, et al. Effect of bariatric surgery on CKD risk. J Am Soc Nephrol. 2018;29(4):1289–300.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Chang AR, Chen Y, Still C, et al. Bariatric surgery is associated with improvement in kidney outcomes. Kidney Int. 2016;90(1):164–71.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Nguyen NT, Blackstone RP, Morton JM, et al. The ASMBS textbook of bariatric surgery: volume 1: bariatric surgery. New York: Springer; 2014.

    Google Scholar 

  15. Kalantar-Zadeh K, Streja E, Molnar MZ, et al. Mortality prediction by surrogates of body composition: an examination of the obesity paradox in hemodialysis patients using composite ranking score analysis. Am J Epidemiol. 2012;175(8):793–803.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Johansen KL, Young B, Kaysen GA, et al. Association of body size with outcomes among patients beginning dialysis. Am J Clin Nutr. 2004;80(2):324–32.

    Article  CAS  PubMed  Google Scholar 

  17. Turgeon NA, Perez S, Mondestin M, et al. The impact of renal function on outcomes of bariatric surgery. J Am Soc Nephrol. 2012;23(5):885–94.

    Article  PubMed  Google Scholar 

  18. Saleh F, Kim SJ, Okrainec A, et al. Bariatric surgery in patients with reduced kidney function: an analysis of short-term outcomes. Surg Obes Relat Dis. 2015;11(4):828–35.

    Article  PubMed  Google Scholar 

  19. Mozer AB, Pender JR, Chapman WH, et al. Bariatric surgery in patients with dialysis-dependent renal failure. Obes Surg. 2015;25(11):2088–92.

    Article  PubMed  Google Scholar 

  20. Jamal MH, Corcelles R, Daigle CR, et al. Safety and effectiveness of bariatric surgery in dialysis patients and kidney transplantation candidates. Surg Obes Relat Dis. 2015;11(2):419–23.

    Article  PubMed  Google Scholar 

  21. Andalib A, Aminian A, Khorgami Z, et al. Safety analysis of primary bariatric surgery in patients on chronic dialysis. Surg Endosc. 2016;30(6):2583–91.

    Article  PubMed  Google Scholar 

  22. Segev DL, Simpkins CE, Thompson RE, et al. Obesity impacts access to kidney transplantation. J Am Soc Nephrol. 2008;19(2):349–55.

    Article  PubMed  PubMed Central  Google Scholar 

  23. American College of Surgeons and American Society of Metabolic and Bariatric Surgery. Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) User Guide for the 2016 Participant Use Data File. (2017).

  24. Levy EM, Viscoli CM, Horwitz RI. The effect of acute renal failure on mortality. A cohort analysis. JAMA. 1996;275(19):1489–94.

    Article  CAS  PubMed  Google Scholar 

  25. Lassnigg A, Schmidlin D, Mouhieddine M, et al. Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: a prospective cohort study. J Am Soc Nephrol. 2004;15(6):1597–605.

    Article  CAS  PubMed  Google Scholar 

  26. United States Renal Data System. Annual data report: atlas of chronic kidney disease and end-stage renal disease in the United States. Bethesda: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2016.

    Google Scholar 

  27. Lee TH, Marcantonio ER, Mangione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100(10):1043–9.

    Article  CAS  Google Scholar 

  28. Gupta PK, Gupta H, Sundaram A, et al. Development and validation of a risk calculator for prediction of cardiac risk after surgery. Circulation. 2011;124(4):381–7.

    Article  PubMed  Google Scholar 

  29. Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol. 2014;64(22):e77–137.

    Article  PubMed  Google Scholar 

  30. Chang SH, Stoll CR, Song J, et al. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012. JAMA Surg. 2014;149(3):275–87.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Abadie A, Drukker D, Herr JL, et al. Implementing matching estimators for average treatment effects in Stata. Stata J. 2004;4:290–311.

    Article  Google Scholar 

  32. Weitzen S, Lapane KL, Toledano AY, et al. Principles for modeling propensity scores in medical research: a systematic literature review. Pharmacoepidemiol Drug Saf. 2004;13(12):841–53.

    Article  PubMed  Google Scholar 

  33. United States Renal Data System. 2017 USRDS annual data report: epidemiology of kidney disease in the United States. Bethesda: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2017.

    Google Scholar 

  34. Gajdos C, Hawn MT, Kile D, et al. Risk of major nonemergent inpatient general surgical procedures in patients on long-term dialysis. JAMA Surg. 2013;148(2):137–43.

    Article  PubMed  Google Scholar 

  35. English WJ, DeMaria EJ, Brethauer SA, et al. American Society for Metabolic and Bariatric Surgery estimation of metabolic and bariatric procedures performed in the United States in 2016. Surg Obes Relat Dis. 2018;14(3):259–63.

    Article  PubMed  Google Scholar 

  36. Varela JE, Nguyen NT. Laparoscopic sleeve gastrectomy leads the U.S. utilization of bariatric surgery at academic medical centers. Surg Obes Relat Dis. 2015;11(5):987–90.

    Article  PubMed  Google Scholar 

  37. Steele KE, Prokopowicz GP, Chang HY, et al. Risk of complications after bariatric surgery among individuals with and without type 2 diabetes mellitus. Surg Obes Relat Dis. 2012;8(3):305–30.

    Article  PubMed  Google Scholar 

  38. Zhang Y, Zheng QJ, Wang S, et al. Diabetes mellitus is associated with increased risk of surgical site infections: a meta-analysis of prospective cohort studies. Am J Infect Control. 2015;43(8):810–5.

    Article  PubMed  Google Scholar 

  39. Livingston EH, Huerta S, Arthur D, et al. Male gender is a predictor of morbidity and age a predictor of mortality for patients undergoing gastric bypass surgery. Ann Surg. 2002;236(5):576–82.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Flum DR, Salem L, Elrod JA, et al. Early mortality among Medicare beneficiaries undergoing bariatric surgical procedures. JAMA. 2005;294(15):1903–8.

    Article  CAS  PubMed  Google Scholar 

  41. Flum DR, Belle SH, King WC, et al. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009;361(5):445–54.

    Article  PubMed  Google Scholar 

  42. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3(1):1–150.

    Article  Google Scholar 

  43. Mehta RL, Kellum JA, Shah SV, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11(2):R31.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Huang TM, Wu VC, Young GH, et al. Preoperative proteinuria predicts adverse renal outcomes after coronary artery bypass grafting. J Am Soc Nephrol. 2011;22(1):156–63.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Mehta RH, Grab JD, O'Brien SM, et al. Bedside tool for predicting the risk of postoperative dialysis in patients undergoing cardiac surgery. Circulation. 2006;114(21):2208–16. quiz 2208

    Article  PubMed  Google Scholar 

  46. Thakar CV, Arrigain S, Worley S, et al. A clinical score to predict acute renal failure after cardiac surgery. J Am Soc Nephrol. 2005;16(1):162–8.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The ACS MBSAQIP and the centers participating in the ACS MBSAQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Grant Information

This research was supported in part by the National Institutes of Health grant number K23-HL133843 (NHLBI, PI: Cohen). The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy of or interpretation by the National Institutes of Health.

Author information

Authors and Affiliations

  1. Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, 831 Blockley, 423 Guardian Drive, Philadelphia, PA, 19104, USA

    Jordana B. Cohen

  2. Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA

    Jordana B. Cohen

  3. Penn Metabolic and Bariatric Surgery Program, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA

    Colleen M. Tewksbury, Noel N. Williams & Kristoffel R. Dumon

  4. Department of Surgery, Oregon Health and Science University, Portland, OR, 97239, USA

    Samuel Torres Landa

Authors
  1. Jordana B. Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Colleen M. Tewksbury
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Samuel Torres Landa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Noel N. Williams
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kristoffel R. Dumon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jordana B. Cohen.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Conflict of Interest

The authors declare that they have no conflicts of interest.

Informed Consent

Does not apply.

Electronic Supplementary Material

ESM 1

(DOCX 42 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cohen, J.B., Tewksbury, C.M., Torres Landa, S. et al. National Postoperative Bariatric Surgery Outcomes in Patients with Chronic Kidney Disease and End-Stage Kidney Disease. OBES SURG 29, 975–982 (2019). https://doi.org/10.1007/s11695-018-3604-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-018-3604-2

Keywords

Search

Navigation