Bariatric surgery in patients with CKD – A five-year assessment

Obesity and its related conditions significantly contribute to the onset of chronic kidney disease (CKD). Metabolic and bariatric surgery (MBS), including sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), is a potential treatment for these patients. However, the increased risk of postoperative complications raises concerns about the appropriateness of MBS in individuals with CKD. 

The aim of a new study was to assess the long-term safety, weight loss, and renal outcomes of MBS in CKD patients.

This was a retrospective review of patients who underwent primary laparoscopic MBS, had a body mass index (BMI) ≥ 35 kg/m², and were diagnosed preoperatively with stage 2-5 CKD. CKD diagnosis and staging were based on estimated glomerular filtration rate (eGFR) measurements following established guidelines. Anthropometric and renal outcomes were evaluated at 3, 6, 12, 24, and 60 months post-surgery.

Overall, 302 patients (177 SG, 125 RYGB) were included. It was noted that RYGB was more frequently performed in patients with stage 3 CKD, while SG was favored in stages 4 and 5. After 5 years, RYGB patients had a greater percentage of total weight loss than SG patients (25.1% vs. 18.6%). Despite more advanced CKD in SG patients, late complications were higher in the RYGB group (8.8% vs. 2.3%). Among patients with preoperative stage 3 CKD, 43.2% improved to stage 2, and 5.1% to stage 1. Additionally, 20.8% of all patients underwent a successful renal transplant.

In conclusion, MBS is a viable option for achieving sustained weight loss in CKD patients with acceptable complication rates. Although RYGB results in more significant weight loss, it also presents a higher risk of late surgical complications. Further research is needed to evaluate the safety of MBS in this population.

Source: Abi Mosleh K, Sample JW, Belluzzi A, et al. Surg Endosc. 2024;38(7):4014-4023.