The number of patients with end-stage renal disease (ESRD) undergoing bariatric surgery increased 9-fold from 2006 to 2016, according to new data published in the Clinical Journal of the American Society of Nephrology.

Laparoscopic sleeve gastrectomy has largely replaced Roux-en-Y gastric bypass as the weight-loss surgery of choice among patients with ESRD. According to Medicare data, sleeve gastrectomy increased from less than 1% of procedures in 2006 to 84% in 2016, Seth Waits, MD, and Kyle Sheetz, MD, MSc, of the University of Michigan in Ann Arbor, and colleagues reported. Notably, patients with ESRD appeared no more likely to experience complications than those without ESRD: 3.4% vs 3.6%, respectively. Patients with ESRD had significantly longer hospitals stays (2.2 vs 1.9 days, respectively) and more hospital readmissions (8.6% vs 5.4%, respectively) than those without ESRD, however.

“This study shows that contemporary trends shifted towards laparoscopic sleeve gastrectomy for patients with kidney failure, likely due to the lower risk of complications and shorter hospital stays,” Dr Sheetz stated in a news release from the American Society of Nephrology.

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In an accompanying editorial, Kevin F. Erickson, MD, MS, and Sankar D. Navaneethan, MD, of Baylor College of Medicine in Houston, recommended “cautious optimism” and discussed several unanswered questions about the long-term safety of bariatric surgery in patients with kidney failure. It remains important for clinicians to monitor post-surgical patients closely for nutritional and electrolyte disorders, and the need for medication dose adjustments, they noted.

“Higher body mass index can limit access to kidney transplantation, and weight loss achieved from bariatric surgery might improve a patient’s likelihood of transplantation,” Dr Erickson and Dr Navaneethan commented.

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Sheetz KH, Woodside KJ, Shahinian VB, Dimick JB, Montgomery JR, and Waits SA. Trends in bariatric surgery procedures among patients with ESKD in the United States. Clin J Am Soc Nephrol. doi:10.2215/CJN.01480219

Erickson KF and Navaneethan SD. Bariatric surgery for ESKD patients: Why, when, and how? Clin J Am Soc Nephrol. doi:10.2215/CJN.07350619

Weight loss surgery rates are rising among US adults with kidney failure [news release]. American Society of Nephrology; July 19, 2019.