About this Research Topic

Background

The prevalence of obesity and chronic kidney disease (CKD) is steadily increasing, and has reached pandemic levels. Although often overlooked, obesity is a risk factor for CKD, and may accelerate its progression. In patients with end-stage renal disease (ESRD), obesity is associated with more difficult clinical management (e.g., complex placement and maintenance of arteriovenous fistulas, increased risk of peritonitis in patients on peritoneal dialysis), may preclude or delay access to a kidney transplant, and may impact peri- and post-transplantation outcomes. Some uncertainty exists, however, on whether all patients with CKD and obesity would benefit from intentional weight loss, due to evidence from observational studies suggesting an “obesity paradox", i.e., a protective association between obesity and survival in ESRD patients, particularly in older patients on haemodialysis.

The nutritional management of patients with obesity and CKD is complex, and varies depending on CKD stage. Preserving fat-free mass during weight loss is particularly challenging due to the dietary restrictions imposed by electrolyte and acid-base imbalances, water and salt retention, and metabolic alterations associated with CKD. The role of anti-obesity medications and bariatric surgery is still under investigation. It is clear that the unmet clinical needs in the context of coexisting obesity and CKD are vast.

The goal of this Research Topic is to increase awareness of the impact that obesity has on kidney outcomes, and to provide evidence-based information that will be useful to improve the nutritional management of patients with obesity and CKD.

We welcome Clinical Trials, Original Research articles, Reviews, and Systematic Reviews covering but not limited to the following themes:
• epidemiology of overweight/obesity in CKD;
• impact of obesity and weight loss on kidney function, including outcomes of kidney transplantation;
• nutritional challenges and strategies to achieve weight loss/improve body composition, including nutritional, pharmacological and surgical management of obesity;
• the obesity paradox;
in patients with obesity and CKD at different stages, from mild dysfunction to end-stage disease, and after kidney transplantation.

Keywords: chronic kidney disease, Kidney transplantation, Bariatric surgery, Nutrition, Obesity paradox, Sarcopenic obesity, Anti-obesity medications

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