Bariatric surgery as a strategy for obesity control in patients with chronic kidney disease: an integrative review

Abstract

Chronic kidney disease (CKD) is a major public health issue due to it’s increasing prevalence and significant clinical and economic burden, with obesity contributing to disease progression and limiting access to kidney transplantation. In this context, bariatric surgery has been considered a potentially safe and effective strategy to control obesity in patients with CKD, improving transplant eligibility and metabolic comorbidities. This study aimed to identify, in the scientific literature, the benefits and risks of bariatric surgery as a strategy for obesity management and clinical improvement in patients with CKD through an integrative review. Studies were searched in PubMed database in Portuguese and English using controlled descriptors. After screening and full-text assessment, 14 studies published were included, with a predominance of retrospective cohorts and narrative/systematic reviews. The findings showed that bariatric surgery leads to significant weight loss and improvement in metabolic conditions such as diabetes mellitus and hypertension, and in some studies, stabilization or improvement of renal function parameters. In patients with end-stage kidney disease, bariatric surgery was frequently reported as an effective way to kidney transplantation, increasing both listing and transplant rates. Although CKD patients may experience a higher risk of perioperative complications compared to the general bariatric population, absolute complication rates were considered acceptable, particularly with sleeve gastrectomy, which demonstrated a more favorable safety profile. In conclusion, bariatric surgery may represent a relevant multidisciplinary therapeutic tool for obesity management in CKD patients, with benefits that may outweigh risks; however, long-term prospective studies are still needed to strengthen evidence and refine surgical indication criteria.