Kidney outcomes after bariatric surgery: a population-based cohort study

Bariatric surgery may mitigate obesity-related chronic kidney disease (CKD) but may concurrently increase the risk of acute kidney injury (AKI) and hyperoxaluria. We examined kidney outcomes after bariatric surgery.

Using population-based registries, we included individuals with Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) in Denmark between 2006 and 2018. These were age- and sex-matched 1:5 to individuals with hospital-diagnosed overweight/obesity without bariatric surgery. Cumulative incidences (risks) of AKI, nephrolithiasis, CKD (stage G3-G5), and kidney failure with replacement therapy (KFRT) were computed, accounting for the competing risk of death. Cox regression was used to estimate hazard ratios (HR) adjusted for age, sex, and comorbidity.

We included 18,827 individuals with bariatric surgery (17,200 RYGB and 1,627 SG) and 94,135 individuals in the matched overweight/obesity cohort (median age 41 years, median follow-up 8.1 years). The one-year risk of AKI following bariatric surgery was 2.7%, while the ten-year risks of nephrolithiasis, CKD, and KFRT were 3.5%, 0.4%, and 0.2%, respectively. When comparing individuals with bariatric surgery with those with overweight/obesity, the adjusted HRs were increased at 1.63 (95% CI; 1.38, 1.92) for AKI and 1.73 (95% CI; 1.56, 1.91) for nephrolithiasis. In contrast, adjusted HRs were decreased at 0.41 (95% CI; 0.26, 0.66) for CKD and 0.63 (95% CI; 0.42, 0.95) for KFRT. Similar results were observed versus a population comparison cohort.

Bariatric surgery was associated with an increased risk of AKI and nephrolithiasis, while long-term risks of CKD and KFRT were lower than in matched individuals with overweight/obesity.