Lin Yu-Min, Kao Chia-Li, Hung Kuo-Chuan, Yu Tsung, Liu Mei-Yuan, Lai Chih-Cheng, Wu Jheng-Yan
Chi Mei Medical Center, Chiali, Tainan, Taiwan.
I-Shou University, Kaohsiung city, Taiwan.
Obes Surg. 2025 Jun 18. doi: 10.1007/s11695-025-07939-w.
Bariatric metabolic surgery (BMS) is an effective intervention for obesity, with proven benefits in reducing cardiovascular events and mortality. However, its impact on patients with chronic kidney disease (CKD) remains unclear. This study aims to evaluate the long-term outcomes of BMS compared to nonsurgical management in CKD patients with obesity, focusing on major adverse cardiovascular events (MACE), major adverse kidney events (MAKE), and all-cause mortality.
We conducted a retrospective cohort study using the TriNetX database, including adult patients with CKD and obesity. Patients who underwent BMS (Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy) were compared to those receiving lifestyle interventions. Propensity score matching (PSM) was applied to balance baseline characteristics. The primary outcome was a composite of all-cause mortality, MACE, and MAKE. Secondary outcomes included individual components of the primary outcome. Cox proportional hazards models and Kaplan-Meier survival analyses were used to assess outcomes across short-term (1 month-1 year), intermediate (up to 3 years), and long-term (up to 5 years) follow-up periods. Subgroup analyses were conducted by CKD stage (1-3 vs. 4-5) to evaluate effect heterogeneity across different levels of kidney function.
After matching, 5,221 patients were included in each group. Over a 5-year follow-up, BMS was associated with significantly lower risk of the primary composite outcome (HR 0.75, 95% CI 0.70-0.81; p < 0.001). Subgroup analyses showed that this protective effect was observed across all CKD stages, with a more pronounced reduction in MAKE among patients with advanced CKD (stages 4-5) compared to early-stage CKD (stages 1-3). BMS was also associated with greater preservation of eGFR over time compared to controls.
Among adults with obesity and CKD, BMS was associated with lower risks of mortality, MACE, and MAKE, as well as slower decline in kidney function. The benefits were consistent across CKD stages and appeared particularly pronounced in patients with advanced CKD (stages 4-5), highlighting the potential role of BMS in high-risk kidney populations. Further randomized trials are needed to validate these results and refine patient selection criteria.
减重代谢手术（BMS）是治疗肥胖症的一种有效干预措施，已证实其在降低心血管事件和死亡率方面具有益处。然而，其对慢性肾脏病（CKD）患者的影响仍不明确。本研究旨在评估BMS与非手术治疗相比，在肥胖的CKD患者中的长期结局，重点关注主要不良心血管事件（MACE）、主要不良肾脏事件（MAKE）和全因死亡率。
我们使用TriNetX数据库进行了一项回顾性队列研究，纳入患有CKD和肥胖症的成年患者。将接受BMS（ Roux-en-Y胃旁路术或腹腔镜袖状胃切除术）的患者与接受生活方式干预的患者进行比较。应用倾向得分匹配（PSM）来平衡基线特征。主要结局是全因死亡率、MACE和MAKE的综合指标。次要结局包括主要结局的各个组成部分。使用Cox比例风险模型和Kaplan-Meier生存分析来评估短期（1个月至1年）、中期（最长3年）和长期（最长5年）随访期的结局。按CKD分期（1 - 3期与4 - 5期）进行亚组分析，以评估不同肾功能水平下的效应异质性。
匹配后，每组纳入5221例患者。在5年的随访中，BMS与主要综合结局的风险显著降低相关（风险比[HR] 0.75，95%置信区间[CI] 0.70 - 0.81；p < 0.001）。亚组分析表明，在所有CKD分期中均观察到这种保护作用，与早期CKD（1 - 3期）患者相比，晚期CKD（4 - 5期）患者的MAKE降低更为明显。与对照组相比，BMS还与随时间推移更好地保留估算肾小球滤过率（eGFR）相关。
在肥胖和CKD的成年人中，BMS与较低的死亡率、MACE和MAKE风险以及较慢的肾功能下降相关。这些益处在CKD各分期中均一致，并且在晚期CKD（4 - 5期）患者中尤为明显，突出了BMS在高风险肾脏人群中的潜在作用。需要进一步的随机试验来验证这些结果并完善患者选择标准。
