Can manipulations of weight improve prognosis in CKD
Is it true that manipulations of weight improve outcomes in patients with CKD?
Interventions aimed at alleviating obesity are advocated in the general population to prevent long-term deleterious consequences. Such interventions are based on robust evidence linking obesity to adverse outcomes.
Because descriptive studies in patients on renal replacement therapy suggest that obesity may confer a survival benefit rather than a risk, it may be less likely that interventions validated in the general population can be extrapolated to these patients without critical appraisal of the consequences.
There is currently no evidence from clinical trials that have tested the risks versus benefits of weight reduction interventions in dialysis patients. Due to the marked discrepancy between epidemiologic studies of obesity in the general population and in patients on dialysis, any weight loss–based intervention in the latter group would have to proceed with utmost care taken to ensure that no harm is done.
There also has to be openness about the possibility that gain in dry (edema free) weight could in fact be beneficial in this patient population because the complex homeostatic changes occurring in the process of increasing lean body mass end even adiposity may entail short-term benefits.
