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• W4307052522 abstract "The National Kidney Foundation (NKF) and The Obesity Society (TOS) cosponsored a multispecialty international workshop in April 2021 to advance the understanding and management of obesity in adults with chronic kidney disease (CKD). The underlying rationale for the workshop was the accumulating evidence that obesity is a major contributor to CKD and adverse outcomes in individuals with CKD, and that effective treatment of obesity, including lifestyle intervention, weight loss medications, and metabolic surgery, can have beneficial effects. The attendees included a range of experts in the areas of kidney disease, obesity medicine, endocrinology, diabetes, bariatric/metabolic surgery, endoscopy, transplant surgery, and nutrition, as well as patients with obesity and CKD. The group identified strategies to increase patient and provider engagement in obesity management, outlined a collaborative action plan to engage nephrologists and obesity medicine experts in obesity management, and identified research opportunities to address gaps in knowledge about the interaction between obesity and kidney disease. The workshop’s conclusions help lay the groundwork for development of an effective, scientifically based, and multidisciplinary approach to the management of obesity in people with CKD. The National Kidney Foundation (NKF) and The Obesity Society (TOS) cosponsored a multispecialty international workshop in April 2021 to advance the understanding and management of obesity in adults with chronic kidney disease (CKD). The underlying rationale for the workshop was the accumulating evidence that obesity is a major contributor to CKD and adverse outcomes in individuals with CKD, and that effective treatment of obesity, including lifestyle intervention, weight loss medications, and metabolic surgery, can have beneficial effects. The attendees included a range of experts in the areas of kidney disease, obesity medicine, endocrinology, diabetes, bariatric/metabolic surgery, endoscopy, transplant surgery, and nutrition, as well as patients with obesity and CKD. The group identified strategies to increase patient and provider engagement in obesity management, outlined a collaborative action plan to engage nephrologists and obesity medicine experts in obesity management, and identified research opportunities to address gaps in knowledge about the interaction between obesity and kidney disease. The workshop’s conclusions help lay the groundwork for development of an effective, scientifically based, and multidisciplinary approach to the management of obesity in people with CKD. Chronic kidney disease (CKD) is a major public health problem. It is becoming increasingly clear that obesity, which affects more than 650 million people globally, is not only highly prevalent in persons with CKD but is also a prime inducer of CKD and other kidney-related and unrelated adverse outcomes (Fig 1).1Friedman A.N. Kaplan L.M. le Roux C.W. Schauer P.R. Management of obesity in adults with CKD.J Am Soc Nephrol. 2021; 32: 777-790https://doi.org/10.1681/ASN.2020101472Crossref PubMed Scopus (23) Google Scholar, 2World Health OrganizationObesity and overweight fact sheet. WHO Newsroom, June 9, 2021.https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweightDate accessed: April 2, 2021Google Scholar, 3Afshin A. Forouzanfar M.H. et al.GBD 2015 Obesity CollaboratorsHealth effects of overweight and obesity in 195 countries over 25 years.N Engl J Med. 2017; 377: 13-27https://doi.org/10.1056/NEJMoa1614362Crossref PubMed Scopus (3812) Google Scholar Despite the unabated growth in obesity among adults and children,4Fryar C.D. Carroll M.D. Afful J. Prevalence of overweight, obesity, and severe obesity among adults aged 20 and over: United States, 1960-1962 through 2017-2018. NCHS Health E Stats.https://www.cdc.gov/nchs/data/hestat/obesity-adult-17-18/obesity-adult.htmDate accessed: January 29, 2021Google Scholar,5Fryar C.D. Carroll M.D. Afful J. Prevalence of overweight, obesity, and severe obesity among children and adolescents aged 2-19 years: United States, 1963-1965 through 2017-2018. NCHS Health E Stats.https://www.cdc.gov/nchs/data/hestat/obesity-child-17-18/obesity-child.htmDate accessed: January 29, 2021Google Scholar the utility of managing coexisting obesity as a strategy to improve health in persons with CKD is just beginning to be recognized and pursued in earnest. Because of the complexity and heterogeneity of obesity, best management would benefit from a team-based approach that includes a variety of disciplines providing individually tailored lifestyle-based, pharmacological, and/or surgical therapies. Collaborative advocacy efforts of specialists in kidney disease and obesity would also offer an opportunity to improve insurance coverage and payment policies, thereby expanding access to effective care for all patients. In order to address the treatment of obesity in the setting of CKD and related issues, the National Kidney Foundation (NKF) and The Obesity Society (TOS) cosponsored a scientific workshop on the management of obesity in adults with CKD on April 29-30, 2021. In preparation for the workshop, a planning committee appointed by the NKF and TOS defined the overall agenda, developed the topics and questions to be addressed and a plan to disseminate the workshop outcomes, and invited participants from academia, clinical practice, patient groups, industry, and government. Although COVID-19–related restrictions required that the meeting be held virtually, the program was designed to maximize cross-disciplinary and multispecialty interaction and discussion. Accordingly, the invitees included a range of experts in the areas of kidney disease, obesity medicine, diabetes management, metabolic surgery, endoscopic medicine, transplant surgery, and nutrition, along with people living with CKD and obesity. 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. In advance of the workshop, the planning committee provided the participants with an outline of the agenda and access to online prerecorded presentations on several topics related to obesity and kidney disease. The conference agenda and a list of workshop attendees are included in Item S1. The first day of the conference included 3 sessions, each composed of prerecorded presentations with ample time for a live panel and audience discussion. Day 2 included 4 live breakout sessions running in parallel, each focusing on a specific topic defined by the planning committee, followed by a summary of the output of each breakout group and a general discussion among all workshop participants. The conference ended with the development of consensus recommendations and the steps necessary for their implementation. Links to the prerecorded lectures can also be found in Item S1. This article summarizes the main topics reviewed, participant feedback, and output of the workshop discussions. There was considerable discussion on the barriers to effective care of obesity, how these barriers affect patients with coexisting CKD, and potential ways to overcome them. At a basic level, identifying which individuals with obesity have CKD remains a major obstacle. The absence of clear and established criteria for treating obesity in people with CKD and evidence that routine screening for kidney disease in people with obesity improves clinical outcomes were also felt to be major limitations to embracing obesity treatment in this population. Indeed, even deciding on what clearance marker should be used is controversial. Cystatin C is generally considered a more robust marker of kidney filtration than creatinine in the setting of obesity or weight loss, though even it is not entirely independent of lean or fat mass.6Chang A.R. George J. Levey A.S. Coresh J. Grams M.E. Inker L.A. Performance of glomerular filtration rate estimating equations before and after bariatric surgery.Kidney Med. 2020; 2: 699-706.e1https://doi.org/10.1016/j.xkme.2020.08.008Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar, 7Chew-Harris J.S. Florkowski C.M. George P.M. Elmslie J.L. Endre Z.H. The relative effects of fat versus muscle mass on cystatin C and estimates of renal function in healthy young men.Ann Clin Biochem. 2013; 50: 39-46https://doi.org/10.1258/acb.2012.011241Crossref PubMed Scopus (55) Google Scholar, 8Friedman A.N. Moe S. Fadel W.F. et al.Predicting the glomerular filtration rate in bariatric surgery patients.Am J Nephrol. 2014; 39: 8-15https://doi.org/10.1159/000357231Crossref PubMed Scopus (68) Google Scholar, 9Macdonald J. Marcora S. Jibani M. et al.GFR estimation using cystatin C is not independent of body composition.Am J Kidney Dis. 2006; 48: 712-719https://doi.org/10.1053/j.ajkd.2006.07.001Abstract Full Text Full Text PDF PubMed Scopus (144) Google Scholar Therefore, equations to estimate glomerular filtration rate (GFR) that combine serum creatinine and cystatin C could potentially improve on creatinine-based equations in helping guide clinical decision making, research, and public health policy in people undergoing treatment with bariatric/metabolic surgery or anti-obesity medications.6Chang A.R. George J. Levey A.S. Coresh J. Grams M.E. Inker L.A. Performance of glomerular filtration rate estimating equations before and after bariatric surgery.Kidney Med. 2020; 2: 699-706.e1https://doi.org/10.1016/j.xkme.2020.08.008Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar,8Friedman A.N. Moe S. Fadel W.F. et al.Predicting the glomerular filtration rate in bariatric surgery patients.Am J Nephrol. 2014; 39: 8-15https://doi.org/10.1159/000357231Crossref PubMed Scopus (68) Google Scholar Proteinuria, the other major clinical marker of CKD, is also affected by obesity. Proteinuria is usually evaluated by a spot urinary albumin-creatinine ratio (UACR) or sometimes a urinary protein-creatinine ratio (UPCR). Muscle mass is increased in individuals with obesity.10Heymsfield S.B. Arteaga C. McManus C. Smith J. Moffitt S. Measurement of muscle mass in humans: validity of the 24-hour urinary creatinine method.Am J Clin Nutr. 1983; 37: 478-494https://doi.org/10.1093/ajcn/37.3.478Crossref PubMed Scopus (657) Google Scholar Because the ratio’s denominator (ie, urinary creatinine) reflects muscle mass, UACR and UPCR often underestimate proteinuria in people with obesity, leading to underdiagnosis of increased proteinuria and delayed treatment. Weight loss in patients with obesity may also affect UACR or UPCR through loss of lean mass. Use of 24-hour urinary collections rather than spot urine samples to measure urinary albumin or total protein is a way to avoid these pitfalls. There is a need to understand how the degree of adiposity influences health risk in CKD and whether this relationship varies by CKD stage (Fig 2). An example of this is the so-called obesity paradox, where obesity is associated with a higher risk of death in early CKD stages but a lower risk in the setting of dialysis.11Rhee C.M. Ahmadi S.F. Kalantar-Zadeh K. The dual roles of obesity in chronic kidney disease: a review of the current literature.Curr Opin Nephrol Hypertens. 2016; 25: 208-216https://doi.org/10.1097/MNH.0000000000000212Crossref PubMed Scopus (77) Google Scholar Most studies demonstrating the obesity paradox use body mass index (BMI) to define obesity, but BMI is limited in how well it distinguishes between fat and lean compartments or important differences in fat distribution.12Kittiskulnam P. Johansen K.L. The obesity paradox: a further consideration in dialysis patients.Semin Dial. 2019; 32: 485-489https://doi.org/10.1111/sdi.12834Crossref PubMed Scopus (23) Google Scholar These limitations could explain why, in contradistinction to the obesity paradox concept, intentional weight loss in dialysis patients has been associated with lower mortality.13Sheetz K.H. Gerhardinger L. Dimick J.B. Waits S.A. Bariatric surgery and long-term survival in patients with obesity and end-stage kidney disease.JAMA Surg. 2020; 155: 581-588https://doi.org/10.1001/jamasurg.2020.0829Crossref PubMed Scopus (38) Google Scholar Metrics of adiposity of interest beyond BMI include body composition (total fat and lean mass, percent body fat) as well as fat distribution (abdominal visceral and subcutaneous, perinephric, etc). Ultimately, defining obesity using an objective standard that is closely linked to kidney function would greatly advance the care of coexisting obesity and CKD. The management of obesity in patients with advanced CKD or kidney failure and after kidney transplantation were topics of particular interest. Among the issues that require further study in these populations were high-priority areas such as the health risks of ongoing obesity and acute weight gain posttransplant and the benefits and risks of weight loss from medical therapy or bariatric/metabolic surgery (Fig 3). A few transplant centers in the United States provide obesity management services including bariatric/metabolic surgery to facilitate kidney transplantation, but the overwhelming majority do not. With respect to commonly used lifestyle-based treatments of obesity, there was agreement that patients experience wide variability in their response to different types of diets, increased physical activity, stress reduction, and improvements in sleep health and normalization of circadian rhythms. As a result, there is no “best” diet for people with obesity with or without CKD, and no diet to date induces sufficient or durable weight loss to demonstrate substantial, long-term improvements in most obesity complications.14Gregg E.W. Chen H. Wagenknecht L.E. et al.Association of an intensive lifestyle intervention with remission of type 2 diabetes.JAMA. 2012; 308: 2489-2496https://doi.org/10.1001/jama.2012.67929Crossref PubMed Scopus (0) Google Scholar Compounding the problem in persons with CKD are current nutrition guidelines, which out of necessity may restrict dietary options and limit dietary protein intake.15Ikizler T. Burrowes J. Byham-Gray L. et al.KDOQI clinical practice guideline for nutrition in CKD: 2020 update.Am J Kidney Dis. 2020; 76: S1-S107https://doi.org/10.1053/j.ajkd.2020.05.006Abstract Full Text Full Text PDF PubMed Scopus (497) Google Scholar This advice may make it harder to preserve muscle mass during weight loss.15Ikizler T. Burrowes J. Byham-Gray L. et al.KDOQI clinical practice guideline for nutrition in CKD: 2020 update.Am J Kidney Dis. 2020; 76: S1-S107https://doi.org/10.1053/j.ajkd.2020.05.006Abstract Full Text Full Text PDF PubMed Scopus (497) Google Scholar,16Cava E. Yeat N.C. Mittendorfer B. Preserving healthy muscle during weight loss.Adv Nutr. 2017; 8: 511-519https://doi.org/10.3945/an.116.014506Abstract Full Text Full Text PDF PubMed Scopus (124) Google Scholar Another issue deserving of further study is the source of dietary protein. For example, protein from animal sources is more likely to promote inflammation and increase GFR and renal plasma flow, which in certain circumstances could have negative effects.17Kontessis P. Jones S. Dodds R. et al.Renal, metabolic and hormonal responses to ingestion of animal and vegetable proteins.Kidney Int. 1990; 38: 136-144https://doi.org/10.1038/ki.1990.178Abstract Full Text PDF PubMed Scopus (210) Google Scholar Whichever lifestyle-based therapies ultimately prove most beneficial for management of obesity in patients with CKD, the limited resources available for intensive lifestyle interventions create a barrier to effective obesity care. The optimal weight loss goal is also unknown and deserves to be explored. Intriguingly, several studies of bariatric surgery have found no clear relationship of changes of weight with albuminuria and estimated GFR.18Fischer H. Weiss R.E. Friedman A.N. Imam T.H. Coleman K.J. The relationship between kidney function and body mass index before and after bariatric surgery in patients with chronic kidney disease.Surg Obes Relat Dis. 2021; 17: 508-515https://doi.org/10.1016/j.soard.2020.11.010Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar, 19Funes D.R. Montorfano L. Blanco D.G. et al.Sleeve gastrectomy in patients with severe obesity and baseline chronic kidney disease improves kidney function independently of weight loss: a propensity score matched analysis.Surg Obes Relat Dis. 2022; 18: 772-778https://doi.org/10.1016/j.soard.2022.02.006Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar, 20Scheurlen K.M. Probst P. Kopf S. Nawroth P.P. Billeter A.T. Muller-Stich B.P. Metabolic surgery improves renal injury independent of weight loss: a meta-analysis.Surg Obes Relat Dis. 2019; 15: 1006-1020https://doi.org/10.1016/j.soard.2019.03.013Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar Whether a similar pattern is seen with lifestyle- or medication-related weight loss is not known. The recent emergence of safe and highly effective anti-obesity medications offers an important new opportunity for obesity treatment. Nephrologists and other clinicians at the workshop who were not obesity medicine specialists emphasized their limited knowledge and lack of experience in using available anti-obesity medications. Many workshop attendees voiced concerns about the safety profile of these agents, mostly based on adverse effects of earlier generations of medications used to treat obesity. The more recent introduction of anti-obesity medications whose safety profile has been established through their routine use for other diseases—for example, topiramate for seizures and migraines, bupropion for depression, and metformin and the glucagon-like peptide 1 (GLP-1) receptor agonists liraglutide or semaglutide for diabetes—and the substantially greater and more durable efficacy of semaglutide should help increase their acceptance among providers and patients (Table 1).21Wilding J.P.H. Calanna S. Kushner R.F. Once-weekly semaglutide in adults with overweight or obesity. Reply.N Engl J Med. 2021; 385: e4https://doi.org/10.1056/NEJMc2106918Crossref PubMed Scopus (0) Google Scholar, 22Davies M. Faerch L. Jeppesen O.K. et al.Semaglutide 2.4 mg once a week in adults with overweight or obesity, and type 2 diabetes (STEP 2): a randomised, double-blind, double-dummy, placebo-controlled, phase 3 trial.Lancet. 2021; 397: 971-984https://doi.org/10.1016/S0140-6736(21)00213-0Abstract Full Text Full Text PDF PubMed Scopus (217) Google Scholar, 23Wadden T.A. Bailey T.S. Billings L.K. et al.Effect of subcutaneous semaglutide vs placebo as an adjunct to intensive behavioral therapy on body weight in adults with overweight or obesity: the STEP 3 randomized clinical trial.JAMA. 2021; 325: 1403-1413https://doi.org/10.1001/jama.2021.1831Crossref PubMed Scopus (206) Google Scholar, 24Rubino D. Abrahamsson N. Davies M. et al.Effect of continued weekly subcutaneous semaglutide vs placebo on weight loss maintenance in adults with overweight or obesity: the STEP 4 randomized clinical trial.JAMA. 2021; 325: 1414-1425https://doi.org/10.1001/jama.2021.3224Crossref PubMed Scopus (208) Google Scholar Several GLP-1 receptor agonists have recently been shown to decrease cardiovascular risk in patients with type 2 diabetes, and there is accumulating evidence that they have renoprotective effects, making them particularly attractive for treating obesity in people with CKD.25Kristensen S.L. Rorth R. Jhund P.S. et al.Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials.Lancet Diabetes Endocrinol. 2019; 7: 776-785https://doi.org/10.1016/S2213-8587(19)30249-9Abstract Full Text Full Text PDF PubMed Scopus (695) Google Scholar A planned randomized controlled trial of semaglutide designed with a primary renal end point will offer useful information on both renoprotection and weight loss benefits in individuals with CKD, type 2 diabetes, and obesity (ClinicalTrials.gov identifier NCT03819153).Table 1US Food and Drug Administration–Approved Anti-obesity MedicationsDrug (Proprietary Name)Mechanism of ActionSelected Common Adverse EffectsKidney-Related PrecautionsDosing AdjustmentsCKD Stage 3-5Kidney FailureLiraglutide (Saxenda)GLP-1 receptor agonistNausea/vomiting, diarrhea, constipation, dyspepsiaNoneUse with caution with severely decreased eGFR (limited data available)Use with caution (limited data)Naltrexone-Bupropion SR (Contrave)Norepinephrine/dopamine uptake inhibitor, opioid antagonistNausea/vomiting, constipation, dizziness, increased HR and BPExcreted primarily via the urineFor moderately and severely decreased eGFR: 1 tablet (8 mg/90 mg) 2×/dNot recommendedOrlistat (Xenical, Alli)Lipase inhibitorFecal incontinence, oily spotting, fat-soluble vitamin deficiencyReports of acute and chronic kidney injury, possibly from oxalate nephropathyNoneNonePhentermine (Adipex-P; Lomaira)Sympathomimetic, anorexicHypertension, palpitations, anxiety, dry mouthExcreted primarily via the urineeGFR of 15-29: maximum dose, 15 g/deGFR < 15: avoid use (not been studied)Phentermine/Topiramate ER (Qsymia)Sympathomimetic, anorexicAs listed above plus drowsiness, mental fogginess, proximal (type 2) RTA, nephrolithiasisExcreted primarily via the urineCLcr < 50: maximum dose, 7.5 mg/46 mg 1×/dDialysis: avoid use (not been studied)Semaglutide, 2.4 (Wegovy)GLP-1 receptor agonistNausea/vomiting, diarrhea, constipation, dyspepsiaAKI with severe GI reactionsNoneNoneSetmelanotide (Imcivree)Melanocortin 4 receptor agonistNausea/vomiting, diarrhea, abdominal pain39% excretion via urineNot recommendedNot recommendedTirzepatide (Mounjaro)GLP-1 receptor agonist/gastric inhibitory polypeptideNausea/vomiting, diarrhea, constipation, dyspepsiaAKI with severe GI reactionsNoneNoneAdapted from Friedman et al1Friedman A.N. Kaplan L.M. le Roux C.W. Schauer P.R. Management of obesity in adults with CKD.J Am Soc Nephrol. 2021; 32: 777-790https://doi.org/10.1681/ASN.2020101472Crossref PubMed Scopus (23) Google Scholar with permission of the copyright holder (original content © 2021 American Society of Nephrology) and supplemented with information in Gossmann et al.58Gossmann M. Butsch W.S. Jastreboff A.M. Treating the chronic disease of obesity.Med Clin North Am. 2021; 105: 983-1016https://doi.org/10.1016/j.mcna.2021.06.005Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar Medications are listed in alphabetical order. Abbreviations: AKI, acute kidney injury; BP, blood pressure; CKD, chronic kidney disease; CLcr, creatinine clearance (in mL/min); eGFR, estimated glomerular filtration rate (in mL/min/1.73 m2); ER, extended release; GI, gastrointestinal; GLP-1, glucagon-like peptide 1; HR, heart rate; RTA, renal tubular acidosis; SR, sustained release. Open table in a new tab Adapted from Friedman et al1Friedman A.N. Kaplan L.M. le Roux C.W. Schauer P.R. Management of obesity in adults with CKD.J Am Soc Nephrol. 2021; 32: 777-790https://doi.org/10.1681/ASN.2020101472Crossref PubMed Scopus (23) Google Scholar with permission of the copyright holder (original content © 2021 American Society of Nephrology) and supplemented with information in Gossmann et al.58Gossmann M. Butsch W.S. Jastreboff A.M. Treating the chronic disease of obesity.Med Clin North Am. 2021; 105: 983-1016https://doi.org/10.1016/j.mcna.2021.06.005Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar Medications are listed in alphabetical order. Abbreviations: AKI, acute kidney injury; BP, blood pressure; CKD, chronic kidney disease; CLcr, creatinine clearance (in mL/min); eGFR, estimated glomerular filtration rate (in mL/min/1.73 m2); ER, extended release; GI, gastrointestinal; GLP-1, glucagon-like peptide 1; HR, heart rate; RTA, renal tubular acidosis; SR, sustained release. The strongest evidence that treating obesity can improve kidney outcomes comes primarily from observational studies.26Aminian A. Zajichek A. Arterburn D.E. et al.Association of metabolic surgery with major adverse cardiovascular outcomes in patients with type 2 diabetes and obesity.JAMA. 2019; 322: 1271-1282https://doi.org/10.1001/jama.2019.14231Crossref PubMed Scopus (199) Google Scholar, 27Chang A.R. Chen Y. Still C. et al.Bariatric surgery is associated with improvement in kidney outcomes.Kidney Int. 2016; 90: 164-171https://doi.org/10.1016/j.kint.2016.02.039Abstract Full Text Full Text PDF PubMed Scopus (125) Google Scholar, 28Doumouras A.G. Lee Y. Paterson J.M. et al.Association between bariatric surgery and major adverse diabetes outcomes in patients with diabetes and obesity.JAMA Netw Open. 2021; 4e216820https://doi.org/10.1001/jamanetworkopen.2021.6820Crossref Scopus (18) Google Scholar, 29Friedman A.N. Wahed A.S. Wang J. et al.Effect of bariatric surgery on CKD risk.J Am Soc Nephrol. 2018; 29: 1289-1300https://doi.org/10.1681/ASN.2017060707Crossref PubMed Scopus (73) Google Scholar, 30Liakopoulos V. Franzén S. Svensson A.M. et al.Renal and cardiovascular outcomes after weight loss from gastric bypass surgery in type 2 diabetes: cardiorenal risk reductions exceed atherosclerotic benefits.Diabetes Care. 2020; 43: 1276-1284https://doi.org/10.2337/dc19-1703Crossref PubMed Scopus (30) Google Scholar, 31O’Brien R. Johnson E. Haneuse S. et al.Microvascular outcomes in patients with diabetes after bariatric surgery versus usual care: a matched cohort study.Ann Intern Med. 2018; 169: 300-310https://doi.org/10.7326/M17-2383Crossref PubMed Scopus (96) Google Scholar, 32Shulman A. Peltonen M. Sjostrom C.D. et al.Incidence of end-stage renal disease following bariatric surgery in the Swedish Obese Subjects Study.Int J Obes (Lond). 2018; 42: 964-973https://doi.org/10.1038/s41366-018-0045-xCrossref PubMed Scopus (52) Google Scholar Inferences from small randomized trials of bariatric/metabolic surgery, which induces the most profound and durable weight loss of any treatment strategy, also exist.33Mingrone G. Panunzi S. De Gaetano A. et al.Metabolic surgery versus conventional medical therapy in patients with type 2 diabetes: 10-year follow-up of an open-label, single-centre, randomised controlled trial.Lancet. 2021; 397: 293-304https://doi.org/10.1016/S0140-6736(20)32649-0Abstract Full Text Full Text PDF PubMed Scopus (156) Google Scholar,34Schauer P.R. Bhatt D.L. Kirwan J.P. et al.Bariatric surgery versus intensive medical therapy for diabetes—5-year outcomes.N Engl J Med. 2017; 376: 641-651https://doi.org/10.1056/NEJMoa1600869Crossref PubMed Scopus (1489) Google Scholar These studies suggest that patients with obesity who undergo bariatric surgery procedures exhibit lower rates of kidney disease, with some evidence of slowed CKD progression.26Aminian A. Zajichek A. Arterburn D.E. et al.Association of metabolic surgery with major adverse cardiovascular outcomes in patients with type 2 diabetes and obesity.JAMA. 2019; 322: 1271-1282https://doi.org/10.1001/jama.2019.14231Crossref PubMed Scopus (199) Google Scholar, 27Chang A.R. Chen Y. Still C. et al.Bariatric surgery is associated with improvement in kidney outcomes.Kidney Int. 2016; 90: 164-171https://doi.org/10.1016/j.kint.2016.02.039Abstract Full Text Full Text PDF PubMed Scopus (125) Google Scholar, 28Doumouras A.G. Lee Y. Paterson J.M. et al.Association between bariatric surgery and major adverse diabetes outcomes in patients with diabetes and obesity.JAMA Netw Open. 2021; 4e216820https://doi.org/10.1001/jamanetworkopen.2021.6820Crossref Scopus (18) Google Scholar, 29Friedman A.N. Wahed A.S. Wang J. et al.Effect of bariatric surgery on CKD risk.J Am Soc Nephrol. 2018; 29: 1289-1300https://doi.org/10.1681/ASN.2017060707Crossref PubMed Scopus (73) Google Scholar, 30Liakopoulos V. Franzén S. Svensson A.M. et al.Renal and cardiovascular outcomes after weight loss from gastric bypass surgery in type 2 diabetes: cardiorenal risk reductions exceed atherosclerotic benefits.Diabetes Care. 2020; 43: 1276-1284https://doi.org/10.2337/dc19-1703Crossref PubMed Scopus (30) Google Scholar, 31O’Brien R. Johnson E. Haneuse S. et al.Microvascular outcomes in patients with diabetes after bariatric surgery versus usual care: a matched cohort study.Ann Intern Med. 2018; 169: 300-310https://doi.org/10.7326/M17-2383Crossref PubMed Scopus (96) Google Scholar, 32Shulman A. Peltonen M. Sjostrom C.D. et al.Incidence of end-stage renal disease following bariatric surgery in the Swedish Obese Subjects Study.Int J Obes (Lond). 2018; 42: 964-973https://doi.org/10.1038/s41366-018-0045-xCrossref PubMed Scopus (52) Google Scholar,35Aminian A. Wilson R. Zajichek A. et al.Cardiovascular outcomes in patients with type 2 diabetes and obesity: comparison of gastric bypass, sleeve gastrectomy, and usual care.Diabetes Care. 2021; 44: 2552-2563https://doi.org/10.2337/dc20-3023Crossref PubMed Scopus (24) Google Scholar,36Young L. Nor Hanipah Z. Brethauer S.A. Schauer P.R. Aminian A. Long-term impact of bariatric surgery in diabetic nephropathy.Surg Endosc. 2019; 33: 1654-1660https://doi.org/10.1007/s00464-018-6458-8Crossref PubMed Scopus (25) Google Scholar A recent proof-of-concept randomized trial showed that bariatric surgery caused greater regression of moderate albuminuria among patients with type 2 diabetes and mild CKD over 2 years compared with intensive medical treatment alone.37Cohen R. Pereira T. Aboud C. et al.Effect of gastric bypass vs best medical treatment on early-stage chronic kidney disease in patients with type 2 diabetes and obesity.JAMA Surg. 2020; 155e200420https://doi.org/10.1001/jamasurg.2020.0420Crossref Scopus (71) Google Scholar F" @default.
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• W4307052522 title "Obstacles and Opportunities in Managing Coexisting Obesity and CKD: Report of a Scientific Workshop Cosponsored by the National Kidney Foundation and The Obesity Society" @default.
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