title: Bariatric surgery in patients with reduced kidney function: an analysis of short-term outcomes.
abstract: BACKGROUND
  With rates of obesity among patients with chronic kidney disease (CKD) mirroring that of the general population, there is growing interest in offering bariatric surgery to these patients. We sought to determine the safety of bariatric surgery in this patient population.
  
  
  METHODS
  Patients who underwent selected laparoscopic bariatric procedures between 2005 and 2011. Estimated glomerular filtration rate (eGFR) was calculated and divided into stages of CKD. Procedures included Roux-en-Y gastric bypass (RYGB), laparoscopic adjustable gastric band (LAGB), and laparoscopic sleeve gastrectomy (SG). Univariable analysis and multivariable adjustment was used to compare complication rates across stages of eGFR.
  
  
  RESULTS
  A total of 64,589 patients were included: 64.5% underwent RYGB, 29.8% LAGB, and 5.7% SG. A total of 61.7% of patients had normal eGFR (Stage 1), 32.0% were stage 2, 5.3% were stage 3, and 1.0% were stage 4/5. After adjusting for relevant patient characteristics, there was a trend toward increasing complications from stage 1 to stage 4/5 CKD among RYGB, LAGB, and SG groups, but none were statistically significant. Similarly, major complications generally increased across stages of CKD for each procedure, but was only significant for RYGB comparing stage 3 to stage 1 (OR 1.22; 95% CI: 1.01-1.47; P = .042) and risk difference .96% (95% CI: .03-1.96). Considering only stage 4/5 CKD, overall (P = .114) and major complications (P = .032) were highest in the RYGB group, followed by SG and LAGB.
  
  
  CONCLUSIONS
  More advanced stages of CKD do not appear to be statistically associated with an increased risk of 30-day postoperative complications.
authors: Division of General Surgery, University Health Network, Toronto, Ontario, Canada.
authors: Fady
authors: F
authors: Saleh
authors: Division of Nephrology, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors: S Joseph
authors: SJ
authors: Kim
authors: Division of General Surgery, University Health Network, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors: Allan
authors: A
authors: Okrainec
authors: Division of General Surgery, University Health Network, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada. Electronic address: Timothy.Jackson@uhn.ca.
authors: Timothy D
authors: TD
authors: Jackson
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000379:methods*; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D009864:Ontario / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss
keywords: ACS NSQIP; Bariatric surgery; Chronic kidney disease; Patient safety; Surgical outcomes