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Does Chronic Kidney Disease Affect Surgical Weight Loss Outcomes and Readmissions?
Tara Mokhtari*, Archana Nair, John M. Morton
Surgery, Stanford University, Stanford, CA
INTRODUCTION
Obesity is associated with renal insufficiency and failure. Chronic kidney disease is a condition known to increase patient morbidity and mortality. While bariatric surgery offers effective, long-term treatment of obesity, the impact of impaired renal function on outcomes following bariatric surgery remains unanswered.
METHODS
Prospective analysis of 1673 patients undergoing laparoscopic bariatric surgery at a single academic institution was undertaken. Demographic, anthropometric, and standard lab data were collected pre- and post-operatively. Pre-op kidney function was assessed through serum creatinine levels (normal Cr≤1.0 mg/dL) and estimated glomerular filtration rate (GFR) calculated using the CDK-EPI equation (normal GFR≥60 mL/min/1.73 m2). Data were analyzed using Student t-test and one-way ANOVA for continuous variables and chi-squared analysis for dichotomous variables. All analysis was performed using GraphPad Prism 6 and STATA.
RESULTS
The mean pre-op serum creatinine across all patients was 0.88 mg/dL. Of 1673 study participants, 1258 underwent Roux-en-Y gastric bypass (RYGB), 154 sleeve gastrectomy (SG), and 261 adjustable gastric banding (AGB). Preoperatively, there were no significant differences in serum creatinine between RYGB, SG, and AGB patients. Patients with elevated pre-op serum creatinine showed a 12-month post-op percent excess weight loss (%EWL) 5.49% lower that patients with normal pre-op creatinine (64.9 %EWL vs. 70.4 %EWL, p=0.004). When analyzed by surgical subtype, there were no significant differences in 12-month %EWL between patients with normal vs. elevated pre-op serum creatinine for any individual procedure. Considering GFR as an indicator of renal function, patients with reduced pre-op GFR below 45 mL/min/1.73 m2 had considerably less %EWL 12-months post-op than patients with normal pre-op GFR (60.3 %EWL vs. 69.7 %EWL, p = 0.04) for all surgeries. With sleeve gastrectomy, reduced 12-month %EWL was seen for patients with pre-op GFR<60 mL/min/1.73 m2 (47.7 %EWL vs. 59.6 %EWL, p=0.0301). Patients with elevated pre-op serum creatinine or reduced pre-op GFR were more likely to require hospital readmission (Cr>1.0: p=0.006; GFR<60: p=0.04).
CONCLUSIONS
Patients with reduced renal function had reduced weight loss following bariatric surgery. Increased serum creatinine was indicative of less post-surgical weight loss across all bariatric surgeries and reduced GFR indicated lower post-op weight loss in sleeve gastrectomy patients. The association between kidney function and post-surgical readmissions highlights the need for special perioperative consideration of bariatric patients with renal impairment.
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