Approaches to patients with obesity and CKD: focus on nutrition and surgery

Abstract

Obesity is recognized as a public health challenge. During the last three decades, the global age-standardized prevalence increased from 8.8% to 18.5% in women and from 4.8% to 14.0% in men, with an absolute current number of 878 million obese subjects. Obesity significantly increases per se the risk of developing disability and chronic diseases, including chronic kidney disease (CKD). Specifically, obesity acts as a major, modifiable cause of CKD onset and progression toward kidney failure; as such, it is considered by the International Society of Nephrology a major health priority. This review analyses the effectiveness, safety and practicability of non-pharmacological anti-obesity interventions in CKD as the different patient phenotypes that may take advantage of personalized approaches.

Keywords: bariatric surgery; chronic kidney disease; ketogenic diet; lifestyle; obesity.

Figure 1:

Obesity treatment pyramid.

Figure 2:

“Obesity-centered” approach as the optimal nutritional strategy for patients with obesity and CKD. RAAS, renin–angiotensin–aldosterone system; K, potassium.

Figure 3:

Main risks and benefits of various dietary patterns considered for the management of patients with obesity and CKD. LCD, low-carbohydrates diet; SFA, saturated fatty acids; TFA, trans fatty acids.

Figure 4:

Laparoscopic bariatric surgery: (A) LSG; (B) LRYGB. Endoluminal bariatric: (C) endoscopic gastroplasty “endo-sleeve” (arrows depict sites of endoscopic stitching in endoscopic sleeve gastroplasty).

Figure 5:

Integrated approach to manage weight losing in patients with overweight (OW) and obesity and CKD according to disease stage (G) and degree of obesity (O) (light colors of interventions in G5 means need of case-by-case evaluation).