The relationship between obesity and chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Abstract

Obesity and chronic kidney disease (CKD) are complex diseases that are interlinked directly and indirectly. In October 2024, Kidney Disease: Improving Global Outcomes (KDIGO) held a Controversies Conference on obesity and CKD to examine the most recent evidence regarding the epidemiology, pathophysiology, and treatment of obesity and CKD as well as to articulate priorities for research. A key conference theme was increasing awareness of obesity-related CKD. Long-term, early-onset obesity and prolonged exposure to obesity carry the highest risk of developing CKD. Identifying early biomarkers of kidney dysfunction and refining assessment methods in the context of obesity could provide opportunities for preventing loss of kidney function. The foundation for managing obesity in CKD comprises modifications to diet, physical activity level, and behaviors related to both. However, these strategies can be unsuccessful in achieving or maintaining weight loss for a myriad of reasons. Pharmacotherapies, such as those including glucagon-like peptide-1 receptor agonists, are effective in weight reduction and have been shown to have kidney-protective and cardiovascular benefits. Metabolic and bariatric surgery has also demonstrated benefits in reducing obesity-related complications. Appropriateness and choice of management strategies will vary depending on age and comorbidities and may change over time. Patient-lead goal setting is a foundation for dietary and physical activity interventions focusing on incremental, achievable changes toward healthy eating and an active lifestyle. Health care professionals require training to deliver these interventions and provide ongoing support with positive messaging using nonjudgmental, stigma-free language. Evaluating the optimal duration of therapy, long-term safety of novel pharmacotherapies, and therapies in the context of early and later stages of CKD is a key priority for research. Multidisciplinary collaboration is important both for optimizing patient care and for advancing research.

Keywords: incretins; kidney disease; metabolic and bariatric surgery; nutrition; obesity; physical activity.