Intensive management of obesity in people with severe chronic kidney disease: A review.

Obesity is highly prevalent worldwide, including among people with chronic kidney disease. The presence of severe and/or end-stage kidney disease, complicates the treatment of obesity for several reasons, including restrictions on protein and fluid intake and renal excretion of several medications indicated for the treatment of obesity. The aim of this review is to assess the safety of intensive obesity treatments, such as very-low-energy diets (VLEDs), obesity pharmacotherapy and/or bariatric surgery, in people with end-stage kidney disease. A literature search was conducted to identify studies reporting safety outcomes for very-low-energy diets, liraglutide, phentermine, phentermine-topiramate, naltrexone-bupropion and bariatric surgery in people with eGFR <30 mL/min/1.73m2 or on dialysis. Limited data was insufficient to recommend VLEDs but highlighted their potential efficacy and the need for close clinical and biochemical monitoring. There was no data regarding centrally-acting obesity pharmacotherapy in this population, although some GLP-1 analogues appear to safely induce weight loss at doses used for the treatment of type 2 diabetes. Some studies suggest an increased rate of complications of bariatric surgery in individuals with severe or end-stage CKD. Further prospective evaluation of intensive obesity management in the growing population with obesity and severe, end-stage and dialysis-dependent CKD is required. This article is protected by copyright. All rights reserved.