Obesity and kidney disease: a big dilemma.

PURPOSE OF REVIEW: Obesity is the number one preventable risk factor for chronic kidney disease. Obesity is, however, associated with improved survival in patients with end-stage renal disease (ESRD). RECENT
FINDINGS: Multiple observational studies have documented an association between obesity and risk of kidney disease even after adjustment for obesity-related co-morbid conditions, including diabetes. Prevalence of a body mass index of at least 35 kg/m among incident dialysis patients has increased by 64% over the past decade, and if trends continue 20% of all patients will initiate dialysis with this degree of obesity. Weight loss improves glomerular hemodynamics in morbidly obese adults and may retard progression of chronic kidney disease. In contrast, once a patient reaches ESRD, the degree of adiposity correlates with survival, and weight loss may not necessarily be beneficial.
SUMMARY: Weight loss appears to be beneficial in obese patients both with and without chronic kidney disease. The safety of intentional weight loss in obese ESRD patients, however, remains questionable. The preclusion of obese ESRD patients from kidney transplantation needs to be readdressed and more studies are needed to determine effective strategies for addressing the obesity epidemic in the chronic kidney disease and ESRD populations.