Obesity and cardionephrology – guidance on the management

7th International Congress of Cardionephrology KARNEF (2025) [pp. 195-200]

AUTHOR(S) / АУТОР(И): Radovan Hojs , Robert Ekart, Sebastjan Bevc, Nina Vodošek Hojs

Download Full Pdf   

DOI: 10.46793/KARNEF25.204H

ABSTRACT / САЖЕТАК:

There is a pandemic of obesity worldwide. There is compelling evidence that obesity is associated with chronic kidney disease (CKD). Studies have shown that high body mass index is strongly related to the risk of CKD, progression of CKD and end-stage renal disease, also after adjustment for age, sex, race, smoking status, comorbidities, and laboratory tests.

Obesity increases the risk of death in people without CKD. In non-dialysis-dependent CKD patients, the association between body-mass index and weight with mortality is controversial. In end-stage renal disease patients, obesity is paradoxically associated with better survival.

Management of obesity in CKD patients includes life-style interventions, pharmacotherapy and bariatric surgery. 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 the general population. The last studies provided clear evidence of kidney and cardiovascular protection with GLP-1 receptor agonists in patients with type 2 diabetes and CKD, and also in overweight/obese patients with CKD without diabetes.

KEYWORDS / КЉУЧНЕ РЕЧИ:

chronic kidney disease, cardiovascular disease, obesity, management

REFERENCES / ЛИТЕРАТУРА:

  • von Ruesten A, Steffen A, Floegel A, et al. Trend in obesity prevalence in European adult cohort populations during follow-up since 1996 and their predictions to 2015. PLoS One 2011; 6:e27455. 
  • Hughes V. The big fat truth. Nature 2013; 497:428-30. 
  • Fox CS, Larson MG, Leip EP, Culleton B, Wilson PW, Levy D. Predictors of new-onset kidney disease in a community-based population. JAMA. 2004; 291:844-50.
  • Kramer H, Luke A, Bidani A, Cao G, Cooper R, McGee D. Obesity and prevalent and incident CKD: the Hypertension Detection and Follow-Up Program. Am J Kidney Dis 2005; 46:587-94.
  • Hsu CY, McCulloch CE, Iribarren C, Darbinian J, Go AS. Body mass index and risk for end-stage renal disease. Ann Intern Med 2006; 144:21-8.
  • Ejerblad E, Fored CM, Lindblad P, Fryzek J, McLaughlin JK, Nyrén O. Obesity and risk for chronic renal failure. J Am Soc Nephrol 2006; 17:1695-702.
  • Vivante A, Golan E, Tzur D, et al. Body mass index in 1.2 million adolescents and risk for end-stage renal disease. Arch Intern Med 2012; 172:1644-50.
  • Chang AR, Grams ME, Ballew SH, et al. Adiposity and risk of decline in glomerular filtration rate: meta-analysis of individual participant data in a global consortium. BMJ 2019; 364:k5301.
  • Friedman AN. Obesity in CKD: A Promising Path Forward. Clin J Am Soc Nephrol 2022; 17:1817-9.
  • Hojs R, Ekart R, Bevc S, Vodošek Hojs N. Chronic Kidney Disease and Obesity. Nephron 2023; 147:660-4. 
  • Park J, Ahmadi SF, Streja E, et al. Obesity paradox in end-stage kidney disease patients. Prog Cardiovasc Dis 2014;56:415-25.
  • Obermayr RP, Temml C, Gutjahr G, et al. Body mass index modifies the risk of cardiovascular death in proteinuric chronic kidney disease. Nephrol Dial Transplant 2009; 24:2421-8.
  • Lu JL, Kalantar-Zadeh K, Ma JZ, Quarles LD, Kovesdy CP. Association of body mass index with outcomes in patients with CKD. J Am Soc Nephrol 2014; 25:2088-96.
  • Dalrymple LS, Katz R, Kestenbaum B, et al. Chronic kidney disease and the risk of end-stage renal disease versus death. J Gen Intern Med 2011; 26:379-85.
  • Muntner P, Judd SE, Gao L, et al. Cardiovascular risk factors in CKD associate with both ESRD and mortality. J Am Soc Nephrol 2013; 24:1159-65.
  • De Nicola L, Minutolo R, Chiodini P, et al. The effect of increasing age on the prognosis of non-dialysis patients with chronic kidney disease receiving stable nephrology care. Kidney Int 2012; 82:482-8.
  • Babayev R, Whaley-Connell A, Kshirsagar A, et al. Association of race and body mass index with ESRD and mortality in CKD stages 3-4: results from the Kidney Early Evaluation Program (KEEP). Am J Kidney Dis 2013; 61:404-12.
  • Weiner DE, Tighiouart H, Elsayed EF, et al. The relationship between nontraditional risk factors and outcomes in individuals with stage 3 to 4 CKD. Am J Kidney Dis 2008; 51:212-23.
  • Ricardo AC, Madero M, Yang W, et al. Adherence to a healthy lifestyle and all-cause mortality in CKD. Clin J Am Soc Nephrol 2013; 8:602-9.
  • Molnar MZ, Streja E, Kovesdy CP, et al. Associations of body mass index and weight loss with mortality in transplant-waitlisted maintenance hemodialysis patients. Am J Transplant 2011; 11:725-36.
  • Ikizler TA, Kramer HJ, Beddhu S, et al; ASN Kidney Health Guidance Workgroup on Obesity and Kidney Diseases. ASN Kidney Health Guidance on the Management of Obesity in Persons Living with Kidney Diseases. J Am Soc Nephrol 2024; 35:1574-88. 
  • Pi-Sunyer X, Astrup A, Fujioka K, et al; SCALE Obesity and Prediabetes NN8022-1839 Study Group. A Randomized, Controlled Trial of 3.0 mg of Liraglutide in Weight Management. N Engl J Med 2015; 373:11-22.
  • Abdul Wahab R, Cohen RV, le Roux CW. Recent advances in the treatment of patients with obesity and chronic kidney disease. Ann Med 2023; 55:2203517.
  • Wilding JPH, Batterham RL, Calanna S, et al. Once-Weekly semaglutide in adults with overweight or obesity. N Engl J Med 2021; 384:989-1002.
  • Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med 2022; 387:205-16.
  • Perkovic V, Tuttle KR, Rossing P, et al; FLOW Trial Committees and Investigators. Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes. N Engl J Med 2024; 391:109-121. 
  • Colhoun HM, Lingvay I, Brown PM, et al. Long-term kidney outcomes of semaglutide in obesity and cardiovascular disease in the SELECT trial. Nat Med 2024; 30:2058-66.