Weight management strategies for those with chronic kidney disease: A consensus report from the Asia Pacific Society of Nephrology and Australia and New Zealand Society of Nephrology 2016 renal dietitians meeting

Jul 26, 2017Nephrology (Carlton, Vic.)

Weight management approaches for people with chronic kidney disease: Agreement from kidney specialists in Asia Pacific and Australia/New Zealand

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Abstract

Two statements achieved group consensus regarding weight management in overweight or obese individuals with chronic kidney disease (CKD).

Current guidelines for estimating energy requirements in overweight and obese individuals with CKD are considered not relevant.
Weight loss medications may be unsafe or ineffective when used alone for individuals with CKD.
Meal replacement formulas are deemed safe and effective for those with CKD.
No consensus was reached on the benefits of weight loss prior to kidney transplantation or the feasibility of traditional weight loss strategies in CKD patients.
Medical or surgical weight loss strategies are not recommended alone and should involve a multidisciplinary team including a renal dietitian.

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AIM: The aim of the present study was to develop a consensus report to guide dietetic management of overweight or obese individuals with chronic kidney disease (CKD).

METHODS: Six statements relating to weight management in CKD guided a comprehensive review of the literature. A summary of the evidence was then presented at the renal nutrition meeting of the 2016 Asia Pacific Society of Nephrology and Australia and New Zealand Society of Nephrology. Majority agreement was defined as group agreement on a statement of between 50-74%, and consensus was considered ≥75% agreement. The recommendations were developed via a mini Delphi process.

RESULTS: Two statements achieved group consensus: the current guidelines used by dietitians to estimate energy requirements for overweight and obese people with CKD are not relevant and weight loss medications may be unsafe or ineffective in isolation for those with CKD. One statement achieved group agreement: Meal replacement formulas are safe and efficacious in those with CKD. No agreement was achieved on the statements of whether there is strong evidence of benefit for weight loss prior to kidney transplantation; whether traditional weight loss strategies can be used in those with CKD and if bariatric surgery in those with end stage kidney disease is feasible and effective.

CONCLUSION: There is a limited evidence base to guide the dietetic management of overweight and obese individuals with CKD. Medical or surgical strategies to facilitate weight loss are not recommended in isolation and require a multidisciplinary approach with the involvement of a skilled renal dietitian.

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Weight management strategies for those with chronic kidney disease: A consensus report from the Asia Pacific Society of Nephrology and Australia and New Zealand Society of Nephrology 2016 renal dietitians meeting

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