CKD and obesity

Jerzy Chudek, MD, is a professor of medicine at the Medical University of Silesia, Poland, and author of numerous publications on angiology, hypertension, and nephrology.

How big a problem is the coexistence of chronic kidney disease (CKD) and obesity? In a person starting renal replacement therapy, is obesity or malnutrition a greater risk?

Obesity is a well-known risk factor for the development of CKD. However, the direct disease related to obesity, the so-called obesity-related nephropathy, is a rare entity. But the influence of obesity on kidney disease is multifactorial. The risk in obesity is related to the occurrence of diabetes, atherosclerosis, and lipid disorders. Therefore, of course, obese people are suffering more frequently from CKD.

At the level of initiation of dialysis therapy, the patients with moderate obesity usually have a better outcome than people starting dialysis therapy being malnourished. In addition, we have the problem of sarcopenic obesity. Also these people with sarcopenic obesity have a worse outcome during dialysis therapy than people with obesity but with a normal muscle mass. Certainly it’s a nutritional status that matters for people starting dialysis therapy. Moderate obesity seems not to be the greatest problem for the patient starting dialysis therapy.