National Postoperative Bariatric Surgery Outcomes in Patients with Chronic Kidney Disease and End-Stage Kidney Disease
National Postoperative Bariatric Surgery Outcomes in Patients with Chronic Kidney Disease and End-Stage Kidney Disease
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DOI：
10.1007/s11695-018-3604-2
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发表时间：
2019-03-01
期刊：
影响因子：
2.9
通讯作者：
Dumon, Kristoffel R.
中科院分区：
文献类型：
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作者：
Cohen, Jordana B.;Tewksbury, Colleen M.;Dumon, Kristoffel R.
目的肥胖是终末期肾病(ESKD)的主要危险因素，也是肾移植的障碍。然而，评估慢性肾脏疾病(CKD)和ESKD患者术后减肥手术结果的证据有限。材料和方法我们使用国家代谢和减肥手术认证和质量改进计划数据集对2015-2016年间接受减肥手术的患者进行了回顾性队列研究。采用倾向性评分匹配的方法平衡CKD、ESKD和非CKD患者之间的特征。结果接受减肥手术的非CKD患者323,034例，CKD患者1694例，ESKD患者925例。与非CKD患者相比，CKD合并ESKD患者30天再手术的风险(CKD优势比[OR]2.25，95%可信区间[CI]1.45~3.51；ESKD OR 3.10，95%CI 1.72~5.61)和再入院风险(CKD OR 1.98，95%CI 1.53~2.56；ESKD OR 2.97，95%CI 2.05~4.31)显著增加；死亡风险在ESKD患者中升高(OR 11.59，95%CI 6.71~20.04)，而在CKD患者中无显著差异(OR 1.00，95%CI 0.32~3.11)。不良结局的发生率为
Purpose Obesity is a major risk factor for end-stage kidney disease (ESKD) and is often a barrier to kidney transplantation. However, limited evidence exists evaluating postoperative bariatric surgery outcomes in patients with chronic kidney disease (CKD) and ESKD.Materials and Methods We performed a retrospective cohort study of patients who underwent bariatric surgery in 2015-2016 using the national Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program dataset. Propensity score matching was used to balance characteristics across patients with CKD and ESKD vs. those without CKD.Results There were 323,034 patients without CKD, 1694 patients with CKD, and 925 patients with ESKD who underwent bariatric surgery. Patients with CKD and ESKD had a significantly increased risk of 30-day reoperation (CKD odds ratio [OR] 2.25 95% confidence interval [CI] 1.45-3.51; ESKD OR 3.10, 95% CI 1.72-5.61) and readmission (CKD OR 1.98, 95% CI 1.53-2.56; ESKD OR 2.97, 95% CI 2.05-4.31) compared to patients without CKD; mortality risk was elevated in patients with ESKD (OR 11.59, 95% CI 6.71-20.04) but not in those with CKD (OR 1.00, 95% CI 0.32-3.11). Rates of adverse outcomes were