Background

Metabolic surgery (MS) improves renal parameters for individuals with obesity and chronic kidney disease (CKD). Despite recognized benefits, concerns persist about the perioperative safety for CKD patients undergoing MS. This study aimed to identify the CKD stage associated with the most significant increase in postoperative complications.

Methods

Using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database (2017-2021), patients undergoing laparoscopic gastric sleeve (SG), or Roux-en-Y gastric bypass (RYGB) were identified. Propensity-matched comparisons were conducted to investigate the risk of adverse outcomes associated with progressive CKD.

Results

A total of 531,701 patients (359,106 without CKD and 172,595 with CKD stages I-V), were examined. Endpoints included infection, serious complications, length of stay (LOS) >5 days, major adverse cardiovascular events (MACE), and death. Both SG and RYGB groups exhibited linear increases in odds of serious complications, MACE, and LOS >5 days with advancing CKD stage. Stage III demonstrated the highest odds for death in both SG (OR = 3.00, 95% CI [1.89, 4.76]) and RYGB groups (OR = 2.10, 95% CI [1.25, 3.52]), while only infection was increased in the SG group, OR 1.12 (95% CI [1.02, 1.22]).

Conclusions

While it is generally accepted that increasing CKD stage correlates with higher surgical risk, this analysis identified CKD stage III as a major inflection point for risk of infectious complications and death. These findings are useful for preoperative counseling and procedure selection and suggest a need for heightened attention to patients in this CKD stage undergoing MS.