Highlights
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oPatients with end-stage renal disease (ESRD) had longer hospital stay after surgery
-
oPatients with ESRD had higher rates of major complications and mortality
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oTotal weight loss was the same between patients with and without ESRD
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oSleeve gastrectomy had fewer postoperative complications in patients with ESRD
Abstract
Background
Bariatric surgery has been suggested as a treatment for obesity and end-stage renal
disease (ESRD). Although the number of bariatric surgeries in patients with ESRD is
increasing, its safety and effectiveness in these patients are still controversial
and the surgical method of choice in these patients is under debate.
Objectives
To compare the outcomes of bariatric surgery between patients with and without ESRD
and to assess different methods of bariatric surgery in patients with ESRD.
Setting
Meta-analysis.
Methods
A comprehensive search was conducted in Web of Science and Medline (via Pubmed) until
May 2022. Tow meta-analyses were performed: A) to compare bariatric surgery outcomes
among patients with and without ESRD, and B) to compare outcomes of Roux-en-Y gastric
bypass (RYGB) and sleeve gastrectomy (SG) in patients with ESRD. Using a random-effect
model, odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI)
were computed for surgical and weight loss outcomes.
Results
Of 5,895 articles, six studies were included in meta-analysis A and eight studies
in meta-analysis B. The risk of bias was moderate to serious among studies. Major
postoperative complications (OR=2.82; 95% CI=1.66–4.77; p=0.0001), reoperation (OR=2.66; 95% CI=1.99–3.56; p<0.00001), readmission (OR=2.37; 95% CI=1.55–3.64; p<0.0001), and in-hospital/90-day mortality (OR=4.03; 95% CI=1.80–9.03; p=0.0007) were higher in patients with ESRD. Patients with ESRD also had a longer hospital
stay (MD=1.23; 95% CI=0.32–2.14; p=0.008). Bleeding, leakage, and total weight loss were comparable among groups. SG
showed a 10% lower rate of overall complications and significantly shorter hospital
stay than RYGB did. The quality of evidence was very low for the outcomes
Conclusions
Bariatric surgery in patients with ESRD seems to have higher rates of major complications
and perioperative mortality than in patients without ESRD, but a comparable rate of
overall complications. SG has fewer postoperative complications and could be the method
of choice in these patients. These findings should be interpreted cautiously in light
of the moderate to high risk of bias in most included studies.
Keywords
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Article info
Publication history
Accepted:
January 14,
2023
Received in revised form:
December 3,
2022
Received:
August 12,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Potential conflicts of interest: None
Funding source: The current meta-analysis was not supported by any grant funding.
Source of Funding
The current meta-analysis was not supported by any grant funding.
Declaration of conflicts of interest
The authors declare no conflicts of interest.
Identification
Copyright
© 2023 Published by Elsevier Inc. on behalf of American Society for Metabolic and Bariatric Surgery.
