Nephrolithiasis after bariatric surgery: A comparison of laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy

Mishra, Tripurari; Shapiro, Jacob B.; Ramirez, Luis D.; Kallies, Kara J.; Kothari, Shanu N.; Londergan, Thomas A.

doi:10.1016/j.amjsurg.2019.09.010

Cited by 12 publications

(16 citation statements)

References 23 publications

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“…Evaluating risk of longer-term postoperative complications amongst those with CKD should be a priority. A meta-analysis by Mishra et al showed that bariatric surgery increased the risk of nephrolithiasis due to enteric hyperoxaluria [23]. The absolute risks of clinically meaningful outcomes relating to enteric hyperoxaluria post-bariatric surgery amongst people with CKD should be better defined, including new-onset nephrolithiasis and oxalate nephropathy.…”

Section: Discussionmentioning

confidence: 99%

The Impact of CKD on Perioperative Risk and Mortality after Bariatric Surgery

et al. 2021

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Background: 20% of patients with chronic kidney disease (CKD) in the United States have a body-mass index (BMI) ≥35 kg/m2. Bariatric surgery reduces progression of CKD to end-stage kidney disease (ESKD), but the risk of perioperative complications remains a concern. Methods: 24-month data spanning 2017-2018 were obtained from the Metabolic and Bariatric Surgery Quality Improvement Program (MBSAQIP) database and analyzed. Surgical complications were assessed based on the length of hospital stay, mortality, reoperation, readmission, surgical site infection (SSI), and worsening of kidney function during the first 30 days after surgery. Results: The 277,948 patients who had primary bariatric procedures were 44±11.9 (mean±SD) years old, 79.6% female, and 71.2% Caucasian. Mean BMI was 45.7±7.6 kg/m2. Compared with patients with an eGFR ≥90 mL/min/BSA, those with stage 5 CKD/ESKD were 1.91 times more likely to be readmitted within 30 days of a bariatric procedure (95% CI, 1.37-2.67; p<0.001). Similarly, length of hospital stay beyond 2 days was 2.05-fold (95% CI, 1.64-2.56; p<0.001) higher and risk of deep incisional surgical site infection was 6.92-fold (95% CI, 1.62-29.52; p=0.009) higher for those with stage 5 CKD/ESKD. Risk of early postoperative mortality increased with declining preoperative eGFR, such that patients with CKD stage 3b were 3.27 (95% CI, 1.82-5.89; p<0.001) times more likely to die compared with those with normal kidney function. However, absolute mortality rates remained relatively low at 0.53% in those with CKD stage 3b. Furthermore, absolute mortality rates were less than 0.5% in those with CKD stages 4 and 5, and these advanced CKD stages were not independently associated with an increased risk of early postoperative mortality. Conclusion: Increased severity of kidney disease was associated with increased complications after bariatric surgery. However, even for the population with advanced CKD, the absolute rates of postoperative complications were low. The mounting evidence for bariatric surgery as a renoprotective intervention in people with and without established kidney disease suggests that bariatric surgery should be considered a safe and effective option for patients with CKD.

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Section: Discussionmentioning

confidence: 99%

The Impact of CKD on Perioperative Risk and Mortality after Bariatric Surgery

et al. 2021

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“…A meta-analysis of 11 observational studies demonstrated that RYGB increases the risk of hyperoxaluria and renal stone formation[ 190 ]. Age, history of urinary tract infection, and renal stone disease correlate with a higher chance of new stone formation after surgery[ 191 , 192 ]. History of nephrolithiasis mandates close urological follow-up post-surgery.…”

Section: Assessment Of Renal Function Electrolytes and Uric Acidmentioning

confidence: 99%

Expert opinion on the preoperative medical optimization of adults with diabetes undergoing metabolic surgery

Bhattacharya¹,

Kalra²,

Kapoor³

et al. 2021

WJD

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Diabetes mellitus (DM) and obesity are interrelated in a complex manner, and their coexistence predisposes patients to a plethora of medical problems. Metabolic surgery has evolved as a promising therapeutic option for both conditions. It is recommended that patients, particularly those of Asian origin, maintain a lower body mass index threshold in the presence of uncontrolled DM. However, several comorbidities often accompany these chronic diseases and need to be addressed for successful surgical outcome. Laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) are the most commonly used bariatric procedures worldwide. The bariatric benefits of RYGB and LSG are similar, but emerging evidence indicates that RYGB is more effective than LSG in improving glycemic control and induces higher rates of long-term DM remission. Several scoring systems have been formulated that are utilized to predict the chances of remission. A glycemic target of glycated hemoglobin < 7% is a reasonable goal before surgery. Cardiovascular, pulmonary, gastrointestinal, hepatic, renal, endocrine, nutritional, and psychological optimization of surgical candidates improves perioperative and long-term outcomes. Various guidelines for preoperative care of individuals with obesity have been formulated, but very few specifically focus on the concerns arising from the presence of concomitant DM. It is hoped that this statement will lead to the standardization of presurgical management of individuals with DM undergoing metabolic surgery.

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“…Weight loss surgery may enable patients to get listed for kidney transplantation as most centers have a BMI cutoff of [35][36][37][38][39][40]…”

Section: Bariatric Surgerymentioning

confidence: 99%

Treatment options for managing obesity in chronic kidney disease

Parvathareddy

Ella

Shah

et al. 2021

Current Opinion in Nephrology &Amp; Hypertension

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Purpose of review Obesity is a risk factor for the development and progression of chronic kidney disease (CKD). In this review, we provide a comprehensive overview of various management options (lifestyle intervention, medications, and bariatric surgery) to address obesity in those with CKD. Recent findings Few clinical trials have examined the benefits of lifestyle modifications in those with preexisting CKD and suggest potential renal and cardiovascular benefits in this population. Yet, superiority of different dietary regimen to facilitate weight loss in CKD is unclear. Although medications could offer short-term benefits and assist weight loss, their safety and long-term benefits warrant further studies in this high-risk population. Observational studies report that bariatric procedures are associated with lower risk of end stage kidney disease. Clinicians should also recognize the higher risk of acute kidney injury, nephrolithiasis, and other complications noted with bariatric surgical procedures. Summary Lifestyle modifications and some weight loss medications may be recommended for facilitating weight loss in CKD. Referral to bariatric centers should be considered among morbidly obese adults with CKD.

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Nephrolithiasis after bariatric surgery: A comparison of laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy

Cited by 12 publications

References 23 publications

The Impact of CKD on Perioperative Risk and Mortality after Bariatric Surgery

The Impact of CKD on Perioperative Risk and Mortality after Bariatric Surgery

Expert opinion on the preoperative medical optimization of adults with diabetes undergoing metabolic surgery

Treatment options for managing obesity in chronic kidney disease

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