Obesity Management in Adults With CKD

All adults, including those with and without CKD, should receive counseling on the benefits of a healthy lifestyle, which includes a healthy diet, physical activity, and smoking cessation. In people with CKD who are overweight, but not obese, potential benefits of weight loss to the recommended "ideal" range are uncertain. Nevertheless, obesity is associated with increased inflammation, insulin resistance, hypertension, and dyslipidemia, and overweight adults with CKD should be counseled about the risks of weight gain. In persons with CKD and generalized or abdominal obesity, weight loss should be encouraged. For patients on dialysis therapy, survival can be greatly increased with kidney transplantation. Patients who are not eligible for transplantation because of obesity should receive lifestyle and medical interventions for weight loss. If nutritional and medical management fails, bariatric surgery by an experienced surgeon at a certified center may be considered. When eligibility for transplantation is not an issue for an obese patient on dialysis therapy, individualized approaches are needed and interventions should emphasize a healthy lifestyle and exercise that can increase muscle mass. Studies are urgently needed to define the benefits and risks of weight loss by means of lifestyle interventions, medications, and surgery for obese patients with CKD. © 2008 National Kidney Foundation, Inc.