Nutritional and Metabolic Management of Obesity and the Metabolic Syndrome in the Patient with Chronic Kidney Disease

Obesity is a 21st century worldwide epidemic that affects all age groups, races, and genders. Mortality risk increased exponentially with obesity severity, and the condition is complicated by chronic diseases such as chronic kidney disease (CKD), diabetes, and hypertension. Obesity may now be considered an important cause of kidney disease. Even moderate obesity nearly doubles the risk of CKD. Obesity-related glomerulopathy (ORG) is a specific form of glomerulomegaly, with or without secondary focal glomerulosclerosis, with heavy proteinuria and glomerular hyperfiltration. Like obesity, the metabolic syndrome is a predictor of CKD. Both conditions are associated with overactivity of the renin-angiotensin system. The benefit of RAS blockade may be greater in the obese patient. Evidence from clinical trials indicates that weight loss can be achieved through lifestyle modification, and may be associated with reduction in blood pressure and proteinuria, and stabilization of kidney function. Bariatric surgery involving procedures such as gastric bypass or banding is increasingly used to achieve durable weight loss and reduce short- and long-term complications of obesity. The use of bariatric surgery in patients with CKD involves a complex combination of benefits and potential risks for the patient.