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

Abstract

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.

Weight Loss in Advanced Chronic Kidney Disease: Should We Consider Individualised, Qualitative, ad Libitum Diets? A Narrative Review and Case Study

“…Conversely, losing weight in the pre-dialysis phase is sometimes reported to slow the progress of kidney disease. This is difficult to evaluate, however, as most trials and series concern relatively early CKD stages, in which the advantage of weight loss may counterbalance the negative effects dieting has on nutritional status [ 41 , 42 , 43 ]. Even less is known about the last phases of CKD.…”

“…The recent consensus statement from the Asian Pacific Society of Nephrology (APSN) underlines the extent to which we lack evidence showing how the dietetic management of overweight and obese individuals with CKD should be approached. While the conclusions reached are rather disheartening, and no real consensus is reached on most of the items discussed, the fact that the APSN statement notes that medical or surgical strategies to facilitate weight loss “require a multidisciplinary approach with the involvement of a skilled renal dietician” indirectly demonstrates the importance of a tailored approach to each CKD patient [ 41 ].…”

“…Yet interestingly, when combining several Medical Subject Headings (MESH) and free terms on obesity, protein restriction, weight loss and CKD we found no relevant reports on Medline. This issue was not even commented on in APSN’s best practice statement, while the association of the two nutritional approaches was contraindicated in a recent statement by the Italian Society of Nephrology [ 41 , 50 ].…”

“…Controlling weight is difficult for all obese patients, whether or not they have CKD, and the results are often disappointing [ 41 , 50 ]. The classic approach of reducing calories conflicts with two of the usual indications for CKD patients: a high calorie intake to minimise the hypercatabolism linked to uraemia, acidosis, and chronic disease; and the negative effect of weight loss in patients starting renal replacement therapy [ 42 ].…”

Accelerated renal function decline in obese post myocardial infarction patients – is weight reduction per se an adequate therapeutic consequence?

“…In line with this, a recent consensus report of renal dietitians did not recommend medical or surgical strategies to facilitate weight reduction in isolation. 4 Kidney function should be considered within the close interactive network of organs, especially the cardiovascular system and metabolism. A healthy cardiovascular system and a balanced metabolism are prerequisites for a normal renal function, thereby highlighting additional healthrelated interventions that surpass the potential goal of weight reduction alone.…”