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Abstract: PO1169

Postoperative Outcomes After Bariatric Surgery in Chronic Dialysis Patients: A Meta-Analysis and Systematic Review

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Palamuthusingam, Dharmenaan, Logan Hospital, Loganholme, Queensland, Australia
  • Hawley, Carmel, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
  • Pascoe, Elaine, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
  • Johnson, David W., Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
  • Fahim, Magid, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
Background

Renal transplantation improves longevity and quality of life for patients on chronic dialysis. However, obesity is a growing surgical contraindication in this group such that bariatric surgery is increasingly being considered as a bridge to transplantation.The risks and benefits of bariatric surgery in the dialysis population have not been synthesized.

Methods

Authors performed a systematic review of observational studies indexed in Embase, MEDLINE and CENTRAL till April 2020 that reported postoperative outcomes in chronic dialysis and non-dialysis patients undergoing bariatric surgery. Summary level data on patient demographics and comorbidity were extracted. The primary outcome was death (30-day or in-hospital mortality); secondary outcomes were myocardial infarction, surgical site infection, pneumonia, unplanned return to theatre, sepsis, and rates of kidney transplantation. Random effects meta-analysis was performed to derive summary risk estimates.

Results

Four cohort studies involving 4,096 chronic dialysis and 732,204 non-dialysis patients undergoing bariatric surgery were included. Sleeve gastrectomy (34%), and roux-en-Y gastric bypass (24%) were the most common procedures performed followed by gastric band or biliopancreatic diversion. There were increased odds of postoperative mortality(0.4-0.5% vs 0.1%; OR 4.7, 95%CI 2.2-9.9,I20%), myocardial infarction(0.0-0.5% vs 0.1%, OR 3.4, 95%CI 2.0-5.9,I20%) and pneumonia(0.3-0.9% vs 0.2-0.4%, OR 2.3, 95%CI 1.1-4.5,I250%) in dialysis patients compared to non-dialysis patients. Patients on dialysis also had increased odds of return to theatre compared to non-dialysis patients (3.2-3.4% vs 1.4-2.0%, OR 2.2, 95%CI 1.7-3.0). There were no differences in the odds of surgical site infections, bleeding, or thromboembolic complications. Rates of renal transplant wait-listing among dialysis patients undergoing bariatric surgery were not reported in any of the studies.

Conclusion

Chronic dialysis patients have substantially increased odds of postoperative mortality and myocardial infarction. However, the absolute rates of complications are low and may not be prohibitive if they facilitate successful renal transplantation. Systematic reporting of both the benefits and risks of bariatric surgery in dialysis patients are needed.

Funding

  • Private Foundation Support