The American Society of Nephrology (ASN) has released its inaugural Kidney Health Guidance (KHG) on the Management of Obesity in Persons Living with Kidney Diseases, providing kidney health professionals and kidney care teams with knowledge on the existing tools for obesity management and guidance on implementation of these tools within clinical practice based on best available evidence and expert opinion. The guidance, ‘ASN Kidney Health Guidance on the Management of Obesity in Persons Living with Kidney Diseases’, was published in the Journal of the American Society of Nephrology (JASN).
The Kidney Health Guidance highlights the importance of individualisation of health and weight loss goals; sensitivity to weight stigma as an essential aspect of care; and the necessity of a comprehensive initial assessment that includes consideration of weight/risk assessment, medical factors/related comorbidities, behavioural health and health-related social needs. The guidance also illuminates advancements in tools to treat obesity, including anti-obesity medications (AOMs) and metabolic and bariatric surgery (MBS), and advocates lifestyle modification to complement alternative interventions to induce and sustain weight loss.
“Kidney health professionals confront the consequences of unhealthy weight for their patients on a daily basis.” said Dr Deidra C Crews. “Obesity is not only a significant risk factor for kidney diseases, it can limit access to and effectiveness of kidney care. With growing interest in new advancements in obesity management, ASN’s Kidney Health Guidance integrates the latest scientific research with practical, multidisciplinary approaches to enhance the quality of life and health outcomes for persons with obesity and kidney diseases.”
The focus on obesity and kidney diseases is intended to illuminate emerging evidence on optimal framing of weight management goals to manage risk of kidney diseases and associated comorbidities. Obesity is associated with the development and progression of chronic kidney disease (CKD) through direct effects on the kidney as well as via intermediate diseases like type 2 diabetes and hypertension.
The guidance notes that weight loss can improve a patient’s psychosocial functioning, including better mood; heighten quality of life; and slow kidney disease progression. However, effectively managing obesity in patients with kidney diseases remains challenging and requires a multidisciplinary team that includes kidney health professionals. Obesity can be treated with lifestyle modifications, such as diet. But, fewer than one in four adults who achieve substantial weight loss with lifestyle intervention sustain the weight loss.
Nevertheless, advancements in tools to treat obesity, including anti-obesity medications (AOMs) and MBS, now allow lifestyle modification to complement alternative interventions to induce and sustain weight loss.
Patients with advanced kidney diseases and those treated with dialysis have higher mortality and complication rates after MBS, than those with earlier stages or no kidney disease. However, absolute mortality rates with metabolic/bariatric surgery are very low regardless of kidney disease stage therefore, selection and optimisation of patients by a multidisciplinary team may help to mitigate risks associated with metabolic/bariatric surgery.
Special considerations should be given to comorbid conditions that increase operative risk, including established cardiovascular disease, uncontrolled hypertension, diabetes and obstructive sleep apnoea, the guidance notes. In addition, patients with severe or uncontrolled psychiatric disorders, eating disorders or active substance use disorders are not considered good surgical candidates.
Furthermore, preoperative nutrition counselling should consider the unique dietary and fluid needs of patients with kidney diseases. Patients receiving maintenance dialysis or with advanced kidney disease are often instructed to restrict their fluid intake. Any fluid restrictions may need to be adjusted, especially during the first few months after MBS when solid food intake may not be tolerated.
The guidance, ‘ASN Kidney Health Guidance on the Management of Obesity in Persons Living with Kidney Diseases’, was published in JASN. To access this paper, please click here
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