Metabolic bariatric surgery versus GLP-1 receptor agonists in dialysis patients with diabetes and obesity: a target trial emulation study
In brief
Bariatric surgery linked to 2.7 times higher 1-year mortality than GLP-1 drugs
In a US study of people with kidney failure, type 2 diabetes and obesity, bariatric surgery was associated with nearly three times the 1-year mortality of GLP-1 drug use, but long-term mortality was comparable. Surgery was also linked to more kidney transplant waitlisting; because this was an observational comparison, whether treatment itself explains these differences remains uncertain.
- Journal
- Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery (Q1)
- Published
- 21 September 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Chenxi Gao, Gayathri Menon, Yusi Chen, Yiting Li, Sunjae Bae, Bonnie E Lonze, et al.
- PMID
- 42907282
- DOI
- 10.1016/j.soard.2026.09.014
Why clinicians should know about it
- Picked for Bariatric and Metabolic Surgery (top studies of the week, 25 October 2026): Direct MBS versus GLP-1 comparison in high-risk dialysis patients
Abstract
BACKGROUND: Metabolic and bariatric surgery (MBS) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) are effective treatments for obesity and type 2 diabetes, but their comparative survival and waitlisting benefits in end-stage kidney disease (ESKD) remain unclear. OBJECTIVES: To compare survival and kidney transplant (KT) waitlisting after MBS and GLP-1RA use among patients with ESKD, using dipeptidyl peptidase-4 inhibitors (DPP-4is) as an active comparator. SETTING: US Renal Data System, 2010-2022. METHODS: We included adults with ESKD, type 2 diabetes, and ≥class II obesity treated with MBS, GLP-1RA, or DPP-4i. Three target trials were emulated: MBS versus GLP-1RA (N = 1818), MBS versus DPP-4i (N = 2111), and GLP-1RA versus DPP-4i (N = 4338). Cox models estimated adjusted hazard ratios (aHRs) for all-cause mortality and KT waitlisting over 1-5 years. RESULTS: MBS recipients were younger at dialysis initiation than matched GLP-1RA and DPP-4i users. MBS was associated with higher short-term mortality than matched GLP-1RA (1-year aHR = 2.68, 95% confidence interval [CI]:1.98-3.63; 3-year aHR = 1.34, 95% CI: 1.09-1.64) and DPP-4i users (1-year aHR = 1.74, 95% CI: 1.35-2.25), but comparable longer-term mortality. GLP-1RA users had consistently lower mortality than matched DPP-4i users. MBS was associated with higher KT waitlisting than GLP-1RA and DPP-4i use, with no differences between GLP-1RA and DPP-4i users. CONCLUSIONS: Among patients with ESKD, type 2 diabetes, and obesity, MBS was associated with higher short-term but comparable long-term mortality, whereas GLP-1RA use was associated with lower mortality than DPP-4i use. MBS was also associated with higher KT waitlisting than GLP-1RA and DPP-4i use, suggesting distinct risk-benefit profiles of metabolic treatment in this high-risk population.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.