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Use of bariatric surgery increased for patients with ESKD and appears to be safe
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Use of bariatric surgery in patients with ESKD, most notably laparoscopic sleeve gastrectomy, rose nine-fold within a decade while also demonstrating a low risk for complications, according to a recently published study.
“This mirrors practice patterns in non-ESKD patient populations, where the modern-day safety of sleeve gastrectomy is comparable in both groups of patients,” Kyle Sheetz, MD, MSc, research fellow at the Center for Healthcare Outcomes and Policy at the University of Michigan, told Healio/Nephrology. “This suggests that ESKD patients are no longer considered to be of prohibitive risk for weight loss surgery.”
As weight loss surgery has the potential to improve health status and increase access to transplantation, researchers sought to describe current trends in bariatric surgery among patients with ESKD, as well as to assess postoperative health outcomes.
To do this, researchers analyzed Medicare data related to all beneficiaries who underwent bariatric surgery (laparoscopic sleeve gastrectomy, laparoscopic Roux-en-Y gastric bypass or laparoscopic gastric banding) between 2006 and 2016, comparing trends and outcomes between those with and without ESKD. In addition, ICD-9/10-CM codes were used to identify 30-day postoperative complications including pulmonary failure, pneumonia, myocardial infarction, deep venous thrombosis/pulmonary embolism, kidney failure, surgical site infection, gastrointestinal bleeding and hemorrhage. The researchers noted that the complication of kidney failure and/or dialysis was only considered for those without ESKD. Hospital readmissions (within 30 days after discharge) and length of stay were also calculated.
Researchers found that, for patients with ESKD, the use of laparoscopic sleeve gastrectomy increased from less than 1% in 2006 to 84% in 2016 (10% increase per year) and that the use of Roux-en-Y gastric bypass decreased from 58% in 2006 to 13% in 2016 (4% decrease per year). Similar trends were observed for those without ESKD.
Researchers observed that complication rates for laparoscopic sleeve gastrectomy were similar between patients with (3.4%) and without ESKD (3.6%). Regarding hospital length of stay and readmission, patients with ESKD were found to have longer stays than those without (2.2 days vs. 1.9 days), as well as more 30-day readmissions (8.6% vs. 5.4%).
Researchers determined that Roux-en-Y bypass was associated with more complications, longer hospital stays and more readmissions for patients both with and without ESKD.
As for further research, Sheetz told Healio/Nephrology that an understanding of how weight loss surgery fits into the larger portfolio of treatments to manage patients with ESKD is needed.
“We also need to better understand specifically how surgery-mediated weight loss influences renal function,” he said. “[In addition], it will be important to understand how weight loss surgery can be used to not only increase candidacy for renal transplantation, but potentially also to improve outcomes. This may be due to patients coming to transplant with more favorable comorbidity profiles as a result of weight loss surgery.”
In a related editorial, Kevin Erickson, MD, and Sankar Navaneethan, MD, both of Baylor College of Medicine, wrote: “While the investigators found relatively low rates of post-surgical complications in the cohort, questions remain about the safety and longer-term impact of bariatric surgery on patient health and access to kidney transplantation. Clinical trials comparing the benefits and risks of these procedures in dialysis population would be ideal. While we wait for those studies, it would be prudent for clinicians to present a balanced assessment of both the potential long-term benefits of weight loss using bariatric procedures and possible negative health impacts to dialysis patients considering bariatric surgery.” – by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.
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