The Impact of CKD on Perioperative Risk and Mortality after Bariatric Surgery.

Autor:	Carvalho Silveira F; Department of Surgery, New York University School of Medicine, New York, New York., Martin WP; Diabetes Complications Research Centre, School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, Dublin 4, Ireland., Maranga G; Department of Surgery, New York University School of Medicine, New York, New York., le Roux CW; Diabetes Complications Research Centre, School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, Dublin 4, Ireland., Ren-Fielding CJ; Department of Surgery, New York University School of Medicine, New York, New York.
Jazyk:	angličtina
Zdroj:	Kidney360 [Kidney360] 2020 Dec 14; Vol. 2 (2), pp. 236-244. Date of Electronic Publication: 2020 Dec 14 (Print Publication: 2021).
DOI:	10.34067/KID.0004832020
Abstrakt:	Background: Twenty percent of patients with CKD in the United States have a body mass index (BMI) ≥35 kg/m 2 . Bariatric surgery reduces progression of CKD to ESKD, but the risk of perioperative complications remains a concern. Methods: The 24-month data spanning 2017-2018 were obtained from the Metabolic and Bariatric Surgery Quality Improvement Program (MBSAQIP) database and analyzed. Surgical complications were assessed on the basis of the length of hospital stay, mortality, reoperation, readmission, surgical site infection (SSI), and worsening of kidney function during the first 30 days after surgery. Results: The 277,948 patients who had primary bariatric procedures were 44±11.9 (mean ± SD) years old, 79.6% were women, and 71.2% were White. Mean BMI was 45.7±7.6 kg/m 2 . Compared with patients with an eGFR≥90 ml/min per BSA, those with stage 5 CKD/ESKD were 1.91 times more likely to be readmitted within 30 days of a bariatric procedure (95% CI, 1.37 to 2.67; P <0.001). Similarly, length of hospital stay beyond 2 days was 2.05-fold (95% CI, 1.64 to 2.56; P <0.001) higher and risk of deep incisional SSI was 6.92-fold (95% CI, 1.62 to 29.52; P =0.009) higher for those with stage 5 CKD/ESKD. Risk of early postoperative mortality increased with declining preoperative eGFR, such that patients with stage 3b CKD were 3.27 (95% CI, 1.82 to 5.89; P <0.001) times more likely to die compared with those with normal kidney function. However, absolute mortality rates remained relatively low at 0.53% in those with stage 3b CKD. Furthermore, absolute mortality rates were <0.5% in those with stages 4 and 5 CKD, and these advanced CKD stages were not independently associated with an increased risk of early postoperative mortality. Conclusions: Increased severity of kidney disease was associated with increased complications after bariatric surgery. However, even for the population with advanced CKD, the absolute rates of postoperative complications were low. The mounting evidence for bariatric surgery as a renoprotective intervention in people with and without established kidney disease suggests that bariatric surgery should be considered a safe and effective option for patients with CKD. Competing Interests: C.W. le Roux reports receiving financial support from AstraZeneca, Boehringer-Ingelheim, Bristol-Myers Squibb, Eli Lilly, GI Dynamics, Janssen, Johnson and Johnson, NovoNordisk, Sanofi Aventis, and Science Foundation Ireland and Health Research Board, outside the submitted work. C.J. Ren-Fielding reports having received financial support from Abbot Laboratories, Apollo Endosurgery U.S. Inc., Covidien LP, Ethicon Inc., W. L. Gore and Associates, Intuitive Surgical Inc., Levita Magnets International Corp., Novo Nordisk Inc., and Orexigen Therapeutics, outside the submitted work. All remaining authors have nothing to disclose. (Copyright © 2021 by the American Society of Nephrology.)
Databáze:	MEDLINE
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