Trends in Bariatric Surgery Procedures among Patients with ESKD in the United States

Clin J Am Soc Nephrol. 2019 Aug 7;14(8):1193-1199. doi: 10.2215/CJN.01480219. Epub 2019 Jul 25.


Background and objectives: Despite the potential for improving health status or increasing access to transplantation, national practice patterns for bariatric surgery in obese patients with ESKD are poorly understood. The purpose of this study was to describe current trends in surgical care for this population.

Design, setting, participants, & measurements: Using 100% Medicare data, we identified all beneficiaries undergoing bariatric surgery in the United States between 2006 and 2016. We evaluated longitudinal practice patterns using linear regression models. We also estimated risk-adjusted complications, readmissions, and length of stay using Poisson regression for patients with and without ESKD.

Results: The number of patients with ESKD undergoing bariatric surgery increased ninefold between 2006 and 2016. The proportional use of sleeve gastrectomy increased from <1% in 2006 to 84% in 2016. For sleeve gastrectomy, complication rates were similar between patients with and without ESKD (3.4% versus 3.6%, respectively; difference, -0.3%; 95% confidence interval, -1.3% to 0.1%; P=0.57). However, patients with ESKD had more readmissions (8.6% versus 5.4%, respectively; difference, 3.2%; 95% confidence interval, 1.9% to 4.6%; P<0.001) and slightly longer hospitals stays (2.2 versus 1.9 days, respectively; difference, 0.3; 95% confidence interval, 0.1 to 0.4; P<0.001).

Conclusions: This study suggests that laparoscopic sleeve gastrectomy has replaced Roux-en-Y gastric bypass as the most common bariatric surgical procedure in patients with ESKD. The data also demonstrate a favorable complication profile in patients with sleeve gastrectomy.

Keywords: Bariatric Surgery; Gastrectomy; Gastric Bypass; Health Status; Kidney Failure, Chronic; Laparoscopy; Medicare; Outcomes; Patient Readmission; obesity.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Bariatric Surgery / statistics & numerical data*
  • Bariatric Surgery / trends*
  • Cohort Studies
  • Female
  • Humans
  • Kidney Failure, Chronic / complications*
  • Male
  • Middle Aged
  • Obesity, Morbid / complications*
  • Obesity, Morbid / surgery*
  • United States