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ASSOCIATION BETWEEN BARIATRIC SURGERY AND MAJOR ADVERSE KIDNEY EVENTS IN PATIENTS WITH CHRONIC KIDNEY DISEASE AND OBESITY: A POPULATION-BASED COHORT STUDY OF MULTIPLE LINKED DATABASE
Yung Lee
*, Sama Anvari, Amber O. Molnar, Michael Walsh, Dennis Hong
General Surgery , McMaster University, Hamilton, ON, Canada
Background: Bariatric surgery is safe and effective in patients with chronic kidney disease (CKD). However, the long-term effect of bariatric surgery on mortality and kidney outcomes in patients with CKD remain unclear.
Methods: We conducted a retrospective, matched cohort study of multiple linked longitudinal databases within Ontario, Canada. Patients with an established diagnosis of CKD (minimum category 3A, eGFR ?60) and a BMI ? 35 were included. We identified eligible patients from the Ontario Bariatric Registry, a registry of all patients who underwent a publicly funded primary bariatric surgery between January 2010 and December 2016 in Ontario. Nonsurgical controls. were matched based on age and sex. . The primary outcomes were all-cause mortality and Major Adverse Kidney Events (MAKE), a composite outcome of all-cause mortality, 50% decline in eGFR from baseline, initiation of dialysis, admission to hospital with heart failure, myocardial infarction (MI), or acute kidney injury (AKI). Outcomes were evaluated through multivariable analyses with cox proportional hazard models.
Results: We included a total of 1538 patients with CKD and severe obesity: 563 that underwent bariatric surgery and 975 nonsurgical controls. Overall, there were 285 total deaths over the follow-up period, with 207 (72.6%) occurring in the nonsurgical cohort and 78 (27.4%) in the surgical cohort (p < 0.001). After the adjusted analysis, patients who received bariatric surgery had 52% lower hazards of mortality compared to the non-surgical control patients (HR 0.48, 95% CI 0.34-0.67, p<0.01). Adjusted hazard ratios also showed significant reductions in the MAKE composite outcome (HR 0.47, 95% CI 0.39-0.57) in the surgical group (p<0.01). Individual components of MAKE composite outcome all demonstrated significantly lower hazards of events in the surgical cohort. Stratified analyses revealed that patients who were female, older, had a higher BMI and worse underlying kidney function had lower risk of mortality and most adverse events included in our composite outcome. Male patients and those with BMI <40 did not appear to derive benefit.
Conclusion: Bariatric surgery is associated with reduced mortality and important CKD-related clinical outcomes, though factors such as patient age, sex, and degree of kidney dysfunction may modify the degree of benefit. Future studies are warranted to determine which population derives the most long-term benefit.
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