Metabolic/Bariatric Surgery is Safe and Effective in People with Obesity, Type 2 Diabetes Mellitus and Chronic Kidney Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Obesity, type 2 diabetes (T2D), and chronic kidney disease (CKD) are thought to increase surgical risks and reduce weight loss after metabolic/bariatric surgery (MBS). Electronic databases were searched between January 2013 and August 2023 for randomized controlled trials (RCT) of MBS reporting data on the safety, total weight loss (TWL), and metabolic control in patients with and without CKD. Forty-four out of 2904 articles were analyzed, representing 1470 patients. No significant differences were found in TWL after 1 year (- 19%, CI - 0.19 to - 0.18 vs.: - 15%, CI - 0.20 to - 0.09, p = 0.13) or after 5 years (- 20%, CI - 0.21 to - 0.18 vs. Group - 16%, CI - 0.28 to - 0.04, p = 0.50).Similarly, there were no significant differences in HbA1c at 1 year (- 1.06, CI - 1.37 to - 0.76 vs. Group 2: - 1.52, CI - 2.25 to - 0.79, p = 0.26) or after 5 years (- 0.97, CI - 1.53 to 0.41 vs. Group 2: - 1.09, CI - 2.21 to 0.03, p = 0.85). For fasting plasma glucose, no differences were seen at 2 years (- 30.43, CI - 60.47 to 0.39 vs. - 35.11, CI - 48.76 to - 21.46, p = 0.78) or after 5 years (- 11.24, CI - 53.38 to 30.89 vs. - 5.4, CI 20.22 to 9.42, p = 0.80). In terms of total cholesterol, no significant differences were found after 1 year (- 10.36, CI - 32.94 to 12.22 vs. - 19.80, CI - 39.46 to - 0.14, p = 0.54) or after 5 years (- 7.43, CI - 25.09 to 5.23 vs. - 21.30, CI - 43.08 to 0.49, p = 0.15). For triglycerides, both showed similar reductions after 1 year (- 76.21, CI - 112.84 to - 39.59 vs. - 78.00, CI - 100.47 to - 55.53, p = 0.94) and after 5 years (- 79.65, CI - 121.09 to - 38.21 vs. - 53.15, CI - 71.14 to - 35.16, p = 0.25). The presence of CKD in patients with obesity and T2D does not reduce the safety and efficacy of MBS.