Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Nov;30(6):561-566.
doi: 10.1053/j.jrn.2020.01.021. Epub 2020 Mar 4.

Approaches to Obesity Management in Dialysis Settings: Renal Dietitian Perspectives

Aditi Suresh  1 , Lucy Robinson  2 , Brandy-Joe Milliron  3 , Kristin Leonberg  4 , Mara McAdams-DeMarco  5 , Carrie Earthman  6 , Ann Klassen  7 , Meera N Harhay  8
Affiliations

Approaches to Obesity Management in Dialysis Settings: Renal Dietitian Perspectives

Aditi Suresh et al. J Ren Nutr. 2020 Nov.

Abstract

Objectives: Over 40% of individuals in the United States with end-stage kidney disease have obesity. Little is known about renal dietitian perspectives on obesity management in the setting of dialysis dependence.

Design and methods: An online 21-item survey was distributed to 118 renal dietitians via individual outreach and a professional organization e-mail listserv. Four themes were explored: the burden of obesity among dialysis patients, concepts of healthy weight loss, weight loss approaches, and challenges of obesity management in dialysis settings. Respondents were asked to rank approaches and biomarkers for obesity management from 0 (least important or not used) to 100 (most important). Free text fields were provided in each category for additional comments.

Results: Thirty-one renal dietitians responded to the survey (26% response rate). The majority of respondents (90%) indicated that access to kidney transplantation was the main reason that dialysis patients with obesity desired weight loss. Calorie restriction was rated as the most common weight loss approach, and dry weight as the most important weight loss biomarker. Nearly 40% of respondents do not alter their nutritional approach when dialysis patients with obesity are losing weight, and 42% of respondents do not monitor changes in waist circumference. Exercise, diet counseling, and stress management were variably prioritized as weight loss management strategies. Barriers to obesity management in dialysis settings included lack of time, lack of training in weight loss counseling, and gaps in current renal nutritional guidelines.

Conclusion: Despite the high prevalence of obesity among individuals with end-stage kidney disease, the results of this survey suggest that current approaches to obesity management in dialysis settings are highly variable. Many renal dietitians lack time to counsel patients on healthy weight loss strategies. Nutritional guidelines are also needed to support people with dialysis dependence and obesity who desire or require weight loss.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Renal dietitian-reported prevalence of weight loss strategies among obese dialysis patients
Figure 2.
Figure 2.
Utilization of surrogates in weight loss management of obese dialysis patients
Figure 3.
Figure 3.
Single greatest challenge of obesity management in dialysis settings for patients (Panel A) and renal dietitians (Panel B), as reported by renal dietitians.
See this image and copyright information in PMC

References

    1. World Health Organization. Global Strategy on Diet, Physical Activity and Health: What is overweight and obesity? World Health Organization. https://www.who.int/dietphysicalactivity/childhood_what/en/. Published 2019. Accessed November 11, 2019.
    1. Saran R, Robinson B, Abbott KC, et al. US Renal Data System 2016 Annual Data Report: Epidemiology of Kidney Disease in the United States. Am J Kidney Dis. 2017;69(3S1):A7–A8. - PMC - PubMed
    1. Lentine KL, Delos Santos R, Axelrod D, Schnitzler MA, Brennan DC, Tuttle-Newhall JE. Obesity and kidney transplant candidates: how big is too big for transplantation? Am J Nephrol. 2012;36(6):575–586. - PubMed
    1. Kalantar-Zadeh K, Rhee CM, Chou J, et al. The Obesity Paradox in Kidney Disease: How to Reconcile it with Obesity Management. Kidney Int Rep. 2017;2(2):271–281. - PMC - PubMed
    1. Kalantar-Zadeh K, Streja E, Kovesdy CP, et al. The obesity paradox and mortality associated with surrogates of body size and muscle mass in patients receiving hemodialysis. Mayo Clin Proc. 2010;85(11):991–1001. - PMC - PubMed

Publication types