Low Energy Diets for Obesity and CKD (SLOW-CKD Randomized Feasibility Study)

doi:10.1016/j.ekir.2025.04.021

. 2025 Apr 21;10(7):2153-2164.

doi: 10.1016/j.ekir.2025.04.021. eCollection 2025 Jul.

Low Energy Diets for Obesity and CKD (SLOW-CKD Randomized Feasibility Study)

Marguerite M Conley^{1

2

3}, Hannah L Mayr^{2

4

5}, Kirsten S Hepburn⁶, Justin J Holland¹, David W Mudge^{3

7

8}, Tammy J Tonges⁹, Richard S Modderman^{10

11}, Sally A Gerzina³, David W Johnson^{3

4

7}, Andrea K Viecelli^{3

4

7}, Helen L MacLaughlin^{1

5

12}

Affiliations

¹ School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.
² Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
³ Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
⁴ Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
⁵ Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Queensland, Australia.
⁶ Kidney Health Service, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
⁷ Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia.
⁸ Redland Hospital, Brisbane, Queensland, Australia.
⁹ Consumer Co-researcher, Brisbane, Queensland, Australia.
¹⁰ Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park South Australia, Australia.
¹¹ Department of Physiotherapy, Sunshine Coast University Hospital, Birtinya, Queensland, Australia.
¹² Nutrition Research Collaborative, Dietetics and Foodservices, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.

PMID: 40677318
PMCID: PMC12266257
DOI: 10.1016/j.ekir.2025.04.021

Low Energy Diets for Obesity and CKD (SLOW-CKD Randomized Feasibility Study)

Marguerite M Conley et al. Kidney Int Rep. 2025.

. 2025 Apr 21;10(7):2153-2164.

doi: 10.1016/j.ekir.2025.04.021. eCollection 2025 Jul.

Authors

Affiliations

¹ School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.
² Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
³ Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
⁴ Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
⁵ Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Queensland, Australia.
⁶ Kidney Health Service, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
⁷ Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia.
⁸ Redland Hospital, Brisbane, Queensland, Australia.
⁹ Consumer Co-researcher, Brisbane, Queensland, Australia.
¹⁰ Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park South Australia, Australia.
¹¹ Department of Physiotherapy, Sunshine Coast University Hospital, Birtinya, Queensland, Australia.
¹² Nutrition Research Collaborative, Dietetics and Foodservices, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.

PMID: 40677318
PMCID: PMC12266257
DOI: 10.1016/j.ekir.2025.04.021

Abstract

Introduction: Low energy diets (LEDs) may slow disease progression; however, their effects are under researched in chronic kidney disease (CKD). This study evaluated the safety and feasibility of an LED weight management program in adults with obesity and CKD.

Methods: This multicenter 6-month randomized controlled trial (RCT) involved adults with CKD Kidney Disease: Improving Global Outcomes stages G1 to G3b, obesity, and proteinuria, randomized 1:1 into 2 groups. The LED group followed a 3-month 800 to 900 kcal/d LED, with dietitian support, then a 3-month weight maintenance phase with exercise and healthy eating support. The usual care (UC) group received standard clinic weight loss support. Primary outcomes were safety (serious adverse events [SAEs]) and feasibility (≥2 of recruitment rate ≥ 25%, LED group retention rate ≥ 75%, and ≥ 30% of LED group achieving ≥ 10 kg weight loss at 3 months). Secondary outcomes included changes in anthropometry, clinical measures, patient-reported outcomes, and participant experiences.

Results: Forty-nine participants (median age 51 years, 57% male) consented. SAEs were low and comparable as follows: 2 in the LED group (hypoglycemia and acute kidney injury) and 2 in the UC group (hypoglycemia), all requiring hospitalization. Feasibility was met for recruitment (46%) and weight loss (46% achieved ≥ 10 kg loss) but not for retention (67% retained). At 6 months, median (IQR) weight change was -9.0 kg (-12 to -7) in the LED group and 0 kg (-4 to 2) in the UC group (P < 0.001).

Conclusion: LEDs under professional guidance are safe and feasible for weight loss in adults with obesity and CKD Kidney Disease: Improving Global Outcomes stages G1 to G3b. A definitive RCT to assess their effects on clinical outcomes and CKD progression is warranted.

Keywords: chronic kidney disease; low energy diet; meal replacement; obesity; weight loss; weight management.

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Figures

**Figure 1**
CONSORT diagram of the SLOW-CKD feasibility study in adults with obesity and chronic kidney disease.

**Figure 2**
Absolute weight loss achieved by adults with obesity and chronic kidney from the SLOW-CKD feasibility study at 3 months by weight loss category.

See this image and copyright information in PMC

References

1. Xu H., Kuja-Halkola R., Chen X., Magnusson P.K.E., Svensson P., Carrero J.J. Higher body mass index is associated with incident diabetes and chronic kidney disease independent of genetic confounding. Kidney Int. 2019;95:1225–1233. doi: 10.1016/j.kint.2018.12.019. - DOI - PubMed
1. Hsu C.Y., McCulloch C.E., Iribarren C., Darbinian J., Go A.S. Body mass index and risk for end-stage renal disease. Ann Intern Med. 2006;144:21–28. doi: 10.7326/0003-4819-144-1-200601030-00006. - DOI - PubMed
1. Dierkes J., Dahl H., Lervaag Welland N., et al. High rates of central obesity and sarcopenia in CKD irrespective of renal replacement therapy - an observational cross-sectional study. BMC Nephrol. 2018;19:259. doi: 10.1186/s12882-018-1055-6. - DOI - PMC - PubMed
1. Evangelista L.S., Cho W.-K., Kim Y. Obesity and chronic kidney disease: a population-based study among South Koreans. PLoS One. 2018;13 doi: 10.1371/journal.pone.0193559. - DOI - PMC - PubMed
1. Afshin A., Forouzanfar M.H., Reitsma M.B., et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017;377:13–27. doi: 10.1056/NEJMoa1614362. - DOI - PMC - PubMed

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[1] Xu H., Kuja-Halkola R., Chen X., Magnusson P.K.E., Svensson P., Carrero J.J. Higher body mass index is associated with incident diabetes and chronic kidney disease independent of genetic confounding. Kidney Int. 2019;95:1225–1233. doi: 10.1016/j.kint.2018.12.019. - DOI - PubMed

[2] Xu H., Kuja-Halkola R., Chen X., Magnusson P.K.E., Svensson P., Carrero J.J. Higher body mass index is associated with incident diabetes and chronic kidney disease independent of genetic confounding. Kidney Int. 2019;95:1225–1233. doi: 10.1016/j.kint.2018.12.019. - DOI - PubMed

[3] Hsu C.Y., McCulloch C.E., Iribarren C., Darbinian J., Go A.S. Body mass index and risk for end-stage renal disease. Ann Intern Med. 2006;144:21–28. doi: 10.7326/0003-4819-144-1-200601030-00006. - DOI - PubMed

[4] Hsu C.Y., McCulloch C.E., Iribarren C., Darbinian J., Go A.S. Body mass index and risk for end-stage renal disease. Ann Intern Med. 2006;144:21–28. doi: 10.7326/0003-4819-144-1-200601030-00006. - DOI - PubMed

[5] Dierkes J., Dahl H., Lervaag Welland N., et al. High rates of central obesity and sarcopenia in CKD irrespective of renal replacement therapy - an observational cross-sectional study. BMC Nephrol. 2018;19:259. doi: 10.1186/s12882-018-1055-6. - DOI - PMC - PubMed

[6] Dierkes J., Dahl H., Lervaag Welland N., et al. High rates of central obesity and sarcopenia in CKD irrespective of renal replacement therapy - an observational cross-sectional study. BMC Nephrol. 2018;19:259. doi: 10.1186/s12882-018-1055-6. - DOI - PMC - PubMed

[7] Evangelista L.S., Cho W.-K., Kim Y. Obesity and chronic kidney disease: a population-based study among South Koreans. PLoS One. 2018;13 doi: 10.1371/journal.pone.0193559. - DOI - PMC - PubMed

[8] Evangelista L.S., Cho W.-K., Kim Y. Obesity and chronic kidney disease: a population-based study among South Koreans. PLoS One. 2018;13 doi: 10.1371/journal.pone.0193559. - DOI - PMC - PubMed

[9] Afshin A., Forouzanfar M.H., Reitsma M.B., et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017;377:13–27. doi: 10.1056/NEJMoa1614362. - DOI - PMC - PubMed

[10] Afshin A., Forouzanfar M.H., Reitsma M.B., et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017;377:13–27. doi: 10.1056/NEJMoa1614362. - DOI - PMC - PubMed

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Low Energy Diets for Obesity and CKD (SLOW-CKD Randomized Feasibility Study)

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Low Energy Diets for Obesity and CKD (SLOW-CKD Randomized Feasibility Study)

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