Obesity and metabolic syndrome represent two of the most pressing global public health challenges, often coexisting and synergistically increasing the risk of cardiovascular and renal complications. Over the past decade, advances in our understanding of the pathophysiological mechanisms underlying chronic kidney disease (CKD) have reshaped our approach to patients with coexisting obesity and CKD. The identification of distinct phenotypes associated with an elevated risk of CKD progression and cardiovascular events, along with the development of novel therapeutic strategies, has contributed to a paradigm shift in clinical management. Currently, therapeutic options such as sodium-glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1 RAs), and their combination with the nonsteroidal mineralocorticoid receptor antagonist finerenone-when added to standard renin-angiotensin-aldosterone system (RAAS) blockade-are available and have shown potential for cardio-renal protection in patients with obesity and/or metabolic syndrome and CKD. In this review, we highlight the complex interplay between obesity and CKD, emphasizing the need for an integrated, multidisciplinary approach. The use of multitargeted therapeutic strategies holds promise in substantially altering the natural course of disease progression, ultimately improving patient outcomes.
