Obesity and cardionephrology – guidance on the management

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.