Obesity Society, National Kidney Foundation Release Report on Managing Coexisting Obesity and Kidney Disease

Allon Friedman, MD

The Obesity Society (TOS) and National Kidney Foundation (NKF) have teamed up to release a unique document they hope will contribute to an improved understanding of the relationship between coexisting obesity and chronic kidney disease (CKD).

Published on October 21, the special report from the NKF and TOS highlights the findings, specifically the opportunities and obstacles identified, from an International, multispecialty, scientific workshop held in 2021 featuring key opinion leaders in nephrology, obesity medicine, diabetes, endocrinology, bariatric surgery, and more.

“The rationale for the workshop was for nephrologists to learn more about obesity from physicians who specialize in treating obesity, and for obesity experts to better understand how kidney disease could affect people with obesity,” said report author Allon N. Friedman, MD, of the Division of Nephrology, School of Medicine, Indiana University, in a statement. “The workshop offered the opportunity for clinicians and scientists from a variety of fields to work together and begin to identify challenges and opportunities in improving care for patients with obesity and CKD.”

A testament to the evolving field of cardiorenal metabolism, the document, which is 11 pages in length, provides an overview of the most prevalent opportunities, hurdles, and research needs in the management of cooccurring obesity and CKD based on contemporary data. Composed by Friedman and a team of 9 colleagues, the document cites 58 references and is broken down into 6 sections dedicated to the obstacles to optimal management of obesity, strategies to improvement patient engagement in obesity management, strategies to engage nephrologists and obesity specialists in managing obesity, strategies to address knowledge gaps, and the document’s conclusion.

To aid in the comprehension of the document, the writing committee composed multiple figures and graphs dedicated to describing the pathophysiology of coexisting obesity and CKD as well as an overview of complications of obesity associated with each progressing stage of CKD. In addition to these graphics, the writing committee also provided a set of 4 boxes outlining potential approaches for each of the aforementioned sections pertaining to strategies to improve management, engage patients, or address knowledge gaps. In the box related to strategies for improving management of obesity in persons with CKD, investigators recommended:

• Design strategies to help identify CKD in the setting of obesity and weight loss.
• Develop criteria for when and how best to treat obesity.
• Educate nephrologists on the importance, role, and effective management of obesity.
• Educate obesity specialists on why, when, and how to screen for kidney disease.
• Identify useful metrics beyond BMI to assess obesity-related health risks.
• Develop recommendations that balance competing dietary needs in CKD patients.
• Address social factors influencing obesity.
• Formulate strategies to improve insurance coverage and reimbursement for weight management.

The report contains an emphasis on the authors’ belief that strategies for engage nephrologists and obesity medicine experts were most likely to be successful if they bridge a common ground, with authors suggesting an initial step to improve engagement would be increased recognition of obesity as a chronic disease with a specific pathophysiology clinicians can target with pharmacologic and surgical options. Other recommendations for improving patient engagement included:

• Educate patients on the interrelationship between obesity and CKD.
• Educate and reassure patients about the biological underpinnings of their obesity.
• Expand obesity support groups to include the CKD population.
• Use nonstigmatizing and nonprejudicial language when addressing obesity.

“Obesity is arguably the most important risk factor in the 21st century for the development and progression of CKD. It is also a major cause in people with pre-existing CKD of worse health outcomes and lower quality of life,” Friedman added.

The study, titled "Obstacles and Opportunities in Managing Coexisting Obesity and CKD: Report of a Scientific Workshop Cosponsored by the National Kidney Foundation and The Obesity Society," will be published in Obesity.