Outcomes After Bariatric Surgery in Older Adults With Obesity and End-Stage Kidney Disease.

OBJECTIVE

Given frailty and comorbidities that occur with both aging and end-stage kidney disease (ESKD), it is unclear if older patients with ESKD derive the improved survival and kidney transplant (KT) access associated with Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG).

METHODS

Using 2006-2021 USRDS data, we identified 876 patients with RYGB and 1508 patients with SG and compared 5-year mortality by age-group (18-29/30-39/40-49/50-59/60-69/≥ 70 years) to nonsurgical matched controls using 1:3 Mahalanobis distance matching, Kaplan-Meier, and Cox regression. We also compared age-stratified KT incidence between waitlisted patients and controls.

RESULTS

Among patients with RYGB versus controls, 5-year mortality was 11.4% versus 17.3% (aHR = 0.230.581.44), 31.5% versus 30.1% (aHR = 0.731.021.41), and 37.9% versus 47.3% (aHR = 0.690.771.00) for 18-29/30-39/40-49 years; however, 5-year mortality was 77.1% versus 68.3% (aHR = 1.241.561.95) for 60-69 years and 86.8% versus 78.7% (aHR = 1.802.393.16) for ≥ 70 years. Among patients with SG versus controls, 5-year mortality was 17.8% versus 30.2% (aHR = 0.260.470.83), 18.1% versus 36.3% (aHR = 0.280.390.53), 28.7% versus 48.9% (aHR = 0.350.430.53), 31.1% versus 61.6% (aHR = 0.270.350.44), 37.3% versus 65.7% (aHR = 0.350.480.66), and 51.5% versus 93.6% (aHR = 0.140.370.94) for 18-29/30-39/40-49/50-59/60-69/≥ 70 years. Among listed ≥ 65 years, KT incidence was 21.3% versus 25.4% (aHR = 0.191.015.26) for patients with RYGB versus controls and 66.7% versus 39.9% (aHR = 0.622.318.64) for patients with SG versus controls.

CONCLUSIONS

RYGB in older patients with ESKD is associated with increased mortality and lower KT likelihood, whereas SG is associated with decreased mortality and higher KT likelihood compared to nonsurgical matched controls. Choice of bariatric surgery type may play a role in improving survival for older patients with ESKD.