Chronic kidney disease and obesity

There is a pandemic of obesity worldwide and in Europe up to 30% of the adult population is already obese. Obesity is strongly related to the risk of CKD, progression of CKD and end-stage renal disease (ESRD), also after adjustment for age, sex, race, smoking status, comorbidities, and laboratory tests. In the general population obesity increases the risk of death. In non-dialysis-dependent CKD patients, the association between body-mass index and weight with mortality is controversial. In ESRD patients, obesity is paradoxically associated with better survival. There are only a few studies investigating changes in weight in these patients and in most weight loss was associated with higher mortality. However, it is not clear if weight change was intentional or unintentional and this is an important limitation of these studies.Management of obesity includes life-style interventions, bariatric surgery and pharmacotherapy. In the last two years a long-acting glucagon like peptide-1 (GLP-1) receptor agonist and GLP-1 and glucose-dependent insulinotropic polypeptide receptor agonist were shown to be effective in managing weight loss in non-CKD patients but we are awaiting results of more definitive studies in CKD patients.

Automated summary

There is a global obesity epidemic, with up to 30% of European adults already being obese. Obesity is closely associated with the risk of CKD, progression of CKD, and ESRD, even after adjusting for various factors. It is unclear whether intentional or unintentional weight loss is linked to higher mortality in CKD patients. Management options for obesity include lifestyle interventions, bariatric surgery, and pharmacotherapy, although more studies are needed for CKD patients.