Nonpharmacologic and Nonsurgical Weight Management Interventions for Patients With Advanced CKD: A Scoping Review of the Medical Literature

Abstract

Rationale & objective: Obesity is associated with morbidity and mortality in people with chronic kidney disease (CKD). Identifying safe and effective nonpharmacologic and nonsurgical interventions to achieve a healthier body weight is essential.

Study design: Scoping review of observational studies and randomized control trials.

Setting & study populations: Adults aged ≥18 years with a body mass index (BMI) ≥30 kg/m² and advanced CKD (category G3-G5D).

Selection criteria for studies: Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews (PRISMA-ScR), we systematically searched 2 electronic databases (MEDLINE and Embase) for studies that examined the effect of nonpharmacologic and nonsurgical interventions for weight loss between January 2010-July 2024. Outcomes included weight loss and BMI. We also examined adherence, whether participants were involved in the design of the study, and adverse events.

Data extraction: Two reviewers screened relevant citations and extracted study characteristics and outcomes. Discrepancies were resolved by a third reviewer.

Analytical approach: Study data were summarized descriptively following guidance from the PRISMA-ScR.

Results: Of the 2,453 citations, 17 met inclusion criteria (9 randomized controlled trials, 2 nonrandomized trials, 5 prospective cohort studies, and 1 retrospective cohort study) and included a total of 960 participants. Interventions included exercise programs, dietary therapy, and/or cognitive behavioral therapy with follow-up ranging from 3-12 months. It appeared that dietary intervention that promoted significant caloric restriction over the short term led to the most weight loss (average, 7 kg). Interventions with monitored coaching appeared helpful. No adverse events were reported. None of the studies involved participants as partners.

Limitations: Not all studies included participants' estimated glomerular filtration rate or BMI category, and we may have included some without severe CKD or BMI ≥30 kg/m².

Conclusions: Programs encouraging very low-energy diets along with monitored coaching, may result in modest short-term weight loss. Patient views on these programs and their longer term success remain unclear.

Keywords: Body mass index; chronic kidney disease; diet; end-stage kidney disease; exercise; obesity; weight loss.

Figure 1

Flow diagram for included and excluded studies.

Figure 2

Changes in weight from baseline in the intervention groups. Summary of absolute weight change (kilograms) from baseline in each of the included studies. Groups in Ikizler et al (2018), Baria et al (2014), and St-Jules et al (2023) reported separately. ∗ = diet and exercise arm, ∗∗ = diet alone arm; § = home-based exercise, §§ = center-based exercise; ¶ = combined education/group counseling/tech-based self-monitoring, ¶¶ = education/tech-based self-monitoring, ¶¶¶ = education/group counseling, ¶¶¶¶ = education alone.

Figure 3

Changes in BMI from baseline in the intervention groups. Summary of the absolute BMI change from baseline in each of the included studies. Groups in Ikizler et al (2018), Aoike et al (2015), and Baria et al (2014) reported separately. ∗ = diet and exercise arm, ¥ = home-based exercise, ¥¥ = center-based exercise; ∗∗ = diet alone arm; § = home-based exercise, §§ = center-based exercise.