ArticleObesity surgery2026
Association Between Preoperative Anemia and Incident Chronic Kidney Disease after Metabolic and Bariatric Surgery: a Propensity Score-matched Cohort Study.
Article in Obesity surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAnemia is associated with incident chronic kidney disease (CKD) and is common after metabolic and bariatric surgery (MBS). Given that preoperative anemia may predict postoperative anemia, this study examined whether preoperative anemia was associated with incident CKD following MBS.
methodsThis propensity score-matched cohort study used data from the TriNetX Research Network. Female patients undergoing laparoscopic sleeve gastrectomy or gastric bypass (2010-2024) were classified by preoperative hemoglobin level (anemia: <12 g/dL; control: ≥12 g/dL). After matching, 7,267 patients remained in each group. The primary outcome was five-year risk of CKD, and secondary outcomes were acute kidney injury (AKI), diabetic kidney complications, and postoperative anemia.
resultsPreoperative anemia was associated with a significantly higher 5-year risk of CKD (hazard ratio[HR] 1.53, 95% confidence interval [CI] 1.16-2.00, P = 0.002), AKI (HR 1.59, 95% CI 1.23-2.06, P < 0.001), and diabetic kidney complications (HR 2.04, 95% CI 1.40-2.98, P < 0.001). Persistent or incident postoperative anemia was markedly more common in the anemia group (HR 2.84, 95% CI 2.71-2.99, P < 0.001), and survival curves showed that intergroup differences appeared earlier for anemia than for CKD. The results remained consistent across sensitivity and subgroup analyses.
conclusionPreoperative anemia was associated with increased 5-year renal risk after MBS. Postoperative anemia was more frequent among these patients, but this temporal association should not be interpreted as evidence of mediation or causality. Preoperative hemoglobin may help identify patients requiring closer renal surveillance, although further validation is needed.
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