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Sleeve gastrectomy and kidney failure

Sleeve gastrectomy increasing among US patients with ESKD

Complication rates for sleeve gastrectomy were similar between patients with and without kidney failure (3.4% vs. 3.6%)

A recent analysis of trends in weight loss surgery among patients with end-stage kidney disease (ESKD) and obesity reveals that sleeve gastrectomy is safe, and its use has increased in recent years and suggest that kidney failure should not be considered a contraindication for bariatric surgery.

As in the general population, obesity rates are rising in individuals with kidney failure. By analysing all Medicare claims for the years 2006 through 2016, a team led by Drs Seth Waits and Kyle Sheetz, (University of Michigan) assessed the extent to which these patients are undergoing and benefiting from bariatric surgery. The study, ‘Trends in Bariatric Surgery Procedures Among Patients with ESKD in the United States’, was published in Clinical Journal of the American Society of Nephrology.

The number of patients with kidney failure undergoing weight loss surgery increased 9-fold between 2006 and 2016. The proportional use of sleeve gastrectomy increased from less than 1% of weight loss surgeries in 2006 to 84% in 2016. Complication rates for sleeve gastrectomy were similar between patients with and without kidney failure (3.4% vs. 3.6%); however, patients with kidney failure had more hospital readmissions (8.6% vs. 5.4%) and slightly longer hospitals stays (2.2 vs. 1.9 days).

“This study shows that contemporary trends shifted towards laparoscopic sleeve gastrectomy for patients with kidney failure, likely due to the lower risk of complications and shorter hospital stays. Weight-loss surgery is now common and generally safe in these patients,” said Sheetz. “The findings from this study suggest that the medical community should focus on determining how best to use weight loss surgery as one tool in the long-term management of patients with kidney failure. It also highlights the potential for greater collaboration between primary care doctors, nephrologists, and surgeons.”

In an accompanying editorial, ‘Bariatric Surgery for ESKD Patients: Why, When, and How?"’, Drs Kevin Erickson and Sankar Navaneethan, (Baylor College of Medicine) noted that although the study found relatively low rates of post-surgical complications, questions remain about the safety and longer-term impact of weight loss surgery on patients' health and their access to kidney transplantation: "Clinical trials comparing the benefits and risks of these procedures in the dialysis population would be ideal," they wrote.

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