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Review
. 2023 Dec;55(1):2203517.
doi: 10.1080/07853890.2023.2203517.

Recent advances in the treatment of patients with obesity and chronic kidney disease

Roshaida Abdul Wahab  1 , Ricardo V Cohen  2 , Carel W le Roux  1
Affiliations
Review

Recent advances in the treatment of patients with obesity and chronic kidney disease

Roshaida Abdul Wahab et al. Ann Med. 2023 Dec.

Abstract

Obesity is a chronic disease characterised by excess adiposity, which impairs health. The high prevalence of obesity raises the risk of long-term medical complications including type 2 diabetes and chronic kidney disease. Several studies have focused on patients with obesity, type 2 diabetes and chronic kidney disease due to the increased prevalence of diabetic kidney disease. Several randomized controlled trials on sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide-1 analogues, and bariatric surgery in diabetic kidney disease showed renoprotective effects. However, further research is critical to address the treatment of patients with obesity and chronic kidney disease to lessen morbidity.Key messageObesity is a driver of chronic kidney disease, and type 2 diabetes, along with obesity, accelerates chronic kidney disease.Several randomized controlled trials on sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide-1 analogues, and bariatric surgery in diabetic kidney disease demonstrate the improvement of renal outcomes.There is a need to address the treatment of patients with obesity and CKD to lessen morbidity.

Keywords: Obesity; bariatric surgery; chronic kidney disease; diabetic kidney disease; glucagon-like peptide-1 analogues; randomized controlled trial; sodium-glucose cotransporter 2 inhibitors.

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Conflict of interest statement

ClR reports grants from the Irish Research Council, Science Foundation Ireland, Anabio, and the Health Research Board. He serves on advisory boards of Novo Nordisk, Herbalife, GI Dynamics, Eli Lilly, Johnson & Johnson, Glia, and Boehringer Ingelheim. ClR is a member of the Irish Society for Nutrition and Metabolism outside the area of work commented on here. He was the chief medical officer and director of the Medical Device Division of Keyron in 2011. Both of these are unremunerated positions. ClR was a previous investor in Keyron, which develops endoscopically implantable medical devices intended to mimic the surgical procedures of sleeve gastrectomy and gastric bypass. The product has only been tested in rodents and none of Keyron’s products is currently licensed. They do not have any contracts with other companies to put their products into clinical practice. No patients have been included in any of Keyron’s studies and they are not listed on the stock market. ClR was gifted stock holdings in September 2021 and divested all stock holdings in Keyron in September 2021. He continues to provide scientific advice to Keyron for no remuneration. RVC reports research grants from Johnson & Johnson Brazil and Medtronic, and serves as the speaker for Johnson & Johnson Brazil and Medtronic. He also serves on advisory boards of Johnson & Johnson Brazil, Medtronic, Keyron, GI Dynamics and Baritek. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Figures

Figure 1.
Figure 1.
A simplified management pathway for obesity and CKD in which bariatric surgery can be employed in the early stage of CKD. SGLT2i, sodium-glucose cotransporter 2 inhibitors;ACEi, angiotensin-converting enzyme inhibitor;ARB, angiotensin receptor blocker;GLP-1a, glucagon-like peptide-1 analogues; CKD, chronic kidney disease;T2D, type 2 diabetes;BP, blood pressure;ESRD, end-stage renal failure.
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