Weight-Loss Interventions in Patients with Overweight/Obesity and CKD

Background: Obesity is an independent risk factor for progression of chronic kidney disease (CKD). We conducted a systematic review and meta-analysis to evaluate the effects of weight loss interventions in patients with non-dialysis-dependent CKD. Methods: We searched Embase, Web of Science, Cochrane, and MEDLINE for randomized controlled trials (RCTs) and pre-specified and post-hoc analyses of RCTs that examined surgical, lifestyle, and pharmacologic interventions in adult patients with CKD and overweight or obesity. We used Cochrane RevMan to perform a random-effects meta-analysis comparing each intervention to its respective control. Weighted mean differences (with 95% confidence intervals) were calculated for various kidney outcome measures. Results: We included 32 studies (from a total of 12,175 studies identified during search). 3 examined surgical interventions, 15 examined lifestyle interventions, and 14 examined pharmacologic interventions (9 of which were GLP-1 agonists). Lifestyle changes were associated with improvements in eGFR, rate of eGFR change, BMI, and weight (Figure). Surgery was associated with significant reductions in weight, BMI, and HbA1c, but no improvements in kidney parameters. Both GLP-1 agonists and other medications were associated with weight loss, but only GLP-1 agonists improved eGFR, rate of eGFR change, and HbA1c. Surgical and lifestyle interventions also improved proteinuria, while some GLP-1 agonist trials demonstrated improvements in urine albumin-creatinine ratio. Conclusion: Weight loss interventions, particularly lifestyle-based and GLP-1 agonists, may confer improvements in kidney function. Larger trials examining kidney outcomes in patients with obesity and CKD are needed to fully elucidate the benefits of such interventions.Figure: Outcomes by Intervention Type. All interventions led to significant reductions in BMI and/or weight. Improvements in eGFR were observed only in lifestyle and GLP-1 agonist trials.