Workshop identifies obstacles, strategies to managing obesity in patients with CKD
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Attendees of a workshop identified several barriers to managing obesity in patients with chronic kidney disease and published their findings in the American Journal of Kidney Diseases.
Further, they suggested strategies to improve obesity management in patients with CKD that included patient engagement and closing the current knowledge gaps.
“In order to address the treatment of obesity in the setting of CKD and related issues, the National Kidney Foundation and The Obesity Society cosponsored a scientific workshop on the management of obesity in adults with CKD on April 29 to 30, 2021,” Allon N. Friedman, MD, a professor of medicine in the division of nephrology at Indiana University, and colleagues wrote. They added, “The goals of the workshop were to develop a clearer delineation of the issues, challenges and knowledge gaps facing the nephrology and obesity medicine communities in advancing the care of obesity in people with CKD and to identify ways to begin to advance the understanding and effective management of these frequently coexisting and closely linked disorders."
Attendees of the workshop included experts of kidney disease, obesity medicine, diabetes management, metabolic surgery, endoscopic medicine, transplant surgery and nutrition, along with patients with CKD and obesity. Attendees identified obstacles to obesity management and discussed how these impacted CKD progression.
According to the paper, there is no standardized method for treating obesity in patients with CKD, nor is there a decided clearance marker for measuring kidney disease in the setting of obesity. Similarly, the presence of obesity impacts the measurement of proteinuria, so treatment can sometimes be delayed if increased proteinuria is underdiagnosed.
There is limited knowledge as to what extend adiposity affects health risk in CKD and if it is varies based on CKD stage. Further, there is no diet that suits all patients who have obesity with or without CKD, nor is there a determined optimal weight loss goal.
Friedman and colleagues wrote, “Barriers common to all obesity management strategies (ie, lifestyle, medications, surgery) include lack of obesity management guidelines for individuals with CKD, lack of reimbursement and insurance coverage and a limited number of referral centers for obesity management, resulting in long wait times or restricted access to expertise.”
The workshop attendees then collaborated on strategies to improve patient, nephrologist and obesity specialist engagement in obesity management and strategies to address knowledge gaps. Many strategies focused on education, whether teaching patients about the interrelationship between obesity and CKD or training medical professionals on using non-stigmatizing language when addressing obesity. To engage nephrologists and obesity specialists in managing obesity, workshop attendees suggested developing a clinical trial evidence base and to work with policymakers to improve reimbursement and to overcome access obstacles.
Friedman and colleagues concluded, “Future progress in this area will require collaboration between the nephrology and obesity medicine communities to educate patients and practitioners; advance our understanding of the relationship between obesity and kidney disease; appreciate the unique characteristics and needs of patients with these disorders; and develop, test, and implement clinical strategies that optimize the health of the growing population with obesity and CKD.”
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