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

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          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, 1,694 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 1.5-2.56; 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 1,000 person-years among patients without CKD, with CKD, and with ESKD, respectively.

          Conclusion:

          Patients with CKD and ESKD experienced higher risk of post-bariatric 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.

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          Author and article information

          Journal
          9106714
          20877
          Obes Surg
          Obes Surg
          Obesity surgery
          0960-8923
          1708-0428
          16 November 2018
          March 2019
          01 March 2020
          : 29
          : 3
          : 975-982
          Affiliations
          [1. ]Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104
          [2. ]Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104
          [3. ]Penn Metabolic and Bariatric Surgery Program, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104
          [4. ]Department of Surgery, Oregon Health and Science University, Portland, OR, 97239
          Author notes
          Corresponding Author: Jordana B. Cohen, MD, MSCE, 831 Blockley, 423 Guardian Drive, University of Pennsylvania, Philadelphia, PA 19104, jco@ 123456pennmedicine.upenn.edu , Phone: 1-267-588-7914, Fax: 1-215-615-0349
          Article
          PMC6430653 PMC6430653 6430653 nihpa1512857
          10.1007/s11695-018-3604-2
          6430653
          30443719
          ec1099bb-b837-43b6-aecd-2dc803617cdc
          Categories
          Article

          weight loss surgery,end stage renal disease,chronic kidney disease,obesity,bariatric surgery

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