Weight Reduction in Patients With Obesity and Impaired Renal Function

Alexander R. Chang, MD, MS


November 17, 2023

Obesity is a growing global epidemic and is a major risk factor for the onset and progression of chronic kidney disease (CKD).

In this ReCAP, Dr Alex Chang, of Geisinger Medical Center in Danville, Pennsylvania, discusses how having overweight or obesity increases the risk for diabetes, high blood pressure, and inflammation, which exacerbate kidney damage and can lead to CKD.

Dr Chang highlights a secondary analysis of the Look AHEAD trial, a large randomized controlled trial that assessed whether an intensive lifestyle intervention (ILI) affects the development of nephropathy in people with type 2 diabetes (T2D). Patients in the ILI group resulted in significant weight loss over time and a reduction in the risk for kidney disease outcomes, both for albuminuria as well as decreased glomerular filtration outcomes.

In addition, he discusses a trial that examines the effects of Roux-en-Y gastric bypass (RYGB) vs best medical treatment on microalbuminuria in patients with T2D, early-stage CKD, and obesity. The primary outcome was remission of albuminuria in 85% of patients who received RYGB.

Finally, Dr Chang reviews medications that promote weight loss and address cardiorenal risk, including glucagon-like peptide 1 receptor agonists and sodium-glucose cotransporter 2 inhibitors. He also cites that tirzepatide, a dual-agonist therapy, may slow estimated glomerular filtration rate decline and reduce albuminuria compared with the insulin glargine.


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