Bariatric surgery and long-term survival in patients with obesity and end-stage kidney disease

1. Bariatric surgery for patients with obesity and end-stage kidney disease was associated with lower all-cause mortality at 5 years.

Evidence Rating: 2 (Good)

Obesity and end-stage kidney disease are significant causes of mortality and morbidity in North America, and represents a significant burden to the healthcare system.  Bariatric Surgery has been associated with lower risks of hyperglycaemia, hypertension, and adverse cardiovascular events in patients with obesity and type 2 diabetes. In patients with end-stage renal disease (ESRD) however, bariatric surgery rates remain low due to speculation of surgical complications and lack of literature demonstrating a clear benefit. To further investigate the benefits or harms of bariatric surgery for obese ESRD patients, researchers conducted a retrospective cohort study with data from the United States Renal Data System registry. Specifically, Cox proportional hazards analysis was used to evaluate differences in long-term survival among 1597 surgical and a matched cohort of 4750 nonsurgical patients with ESRD and obesity. Bariatric surgery was associated with lower all-cause mortality at 5 years compared with standard care (cumulative incidence, 25.6% vs. 39.8%; hazard ratio, 0.69, 95% CI, 0.60-0.78), primarily driven by lower rates of cardiovascular causes (cumulative incidence, 8.4% vs. 17.2%; hazard ratio, 0.51; 95% CI, 0.41-0.65). Interestingly however, bariatric surgery was associated with higher all-cause mortality at one year (cumulative incidence, 8.6% vs. 7.7%; hazard ratio, 1.45; 95% CI, 1.13-1.85), and increase in kidney transplant at 5 years (cumulative incidence, 33.0% vs. 20.4%; adjusted hazard ratio, 1.82; 95% CI, 1.58-2.09). This population-based study of patients with obesity and ESRD found a long term mortality benefit associated with bariatric surgery. Although further investigations need to be carried out to better meaningfully sort out the possible health benefits of bariatric surgery, findings suggest that the health benefits of surgery for patients with obesity can be generalized with patients with concomitant ESRD.

Click to read the study in JAMA Surgery

Image: PD

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