Management of Obesity in Adults with CKD

Abstract

Obesity is a leading public health problem that currently affects over 650 million individuals worldwide. Although interest in the adverse effects of obesity has grown exponentially in recent years, less attention has been given to studying its management in individuals with CKD. This relatively unexplored area should be considered a high priority because of the rapid growth and high prevalence of obesity in the CKD population, its broad impact on health and outcomes, and its modifiable nature. This article begins to lay the groundwork in this field by providing a comprehensive overview that critically evaluates the available evidence related to obesity and kidney disease, identifies important gaps in our knowledge base, and integrates recent insights in the pathophysiology of obesity to help provide a way forward in establishing guidelines as a basis for managing obesity in CKD. Finally, the article includes a kidney-centric algorithm for management of obesity that can be used in clinical practice.

Keywords: GLP-1; arteriovenous access; bariatric surgery; chronic kidney disease; diabetes; kidney transplantation; metabolic surgery; obesity; quality of life; weight loss.

Figure 1.

Suggested algorithm for obesity management in persons with CKD. *Opinion-based recommendations for antiobesity medications include choosing from each of the following groups: group 1: orlistat, phentermine/topiramate, buproprion-naltrexone (all of these are dose adjusted as necessary with monitoring for renal side effects); group 2: GLP-1 agonists (dose adjusted as necessary); and group 3: sodium-glucose cotransporter 2 inhibitors (eGFR>30 ml/min per 1.73 m²). Adapted from Rubino et al., with permission.