title: Obesity and kidney disease: a big dilemma.
abstract: OBJECTIVE
  Obesity is the number one preventable risk factor for chronic kidney disease. Obesity is, however, associated with improved survival in patients with end-stage renal disease (ESRD).
  
  
  RESULTS
  Multiple observational studies have documented an association between obesity and risk of kidney disease even after adjustment for obesity-related co-morbid conditions, including diabetes. Prevalence of a body mass index of at least 35 kg/m among incident dialysis patients has increased by 64% over the past decade, and if trends continue 20% of all patients will initiate dialysis with this degree of obesity. Weight loss improves glomerular hemodynamics in morbidly obese adults and may retard progression of chronic kidney disease. In contrast, once a patient reaches ESRD, the degree of adiposity correlates with survival, and weight loss may not necessarily be beneficial.
  
  
  CONCLUSIONS
  Weight loss appears to be beneficial in obese patients both with and without chronic kidney disease. The safety of intentional weight loss in obese ESRD patients, however, remains questionable. The preclusion of obese ESRD patients from kidney transplantation needs to be readdressed and more studies are needed to determine effective strategies for addressing the obesity epidemic in the chronic kidney disease and ESRD populations.
authors.affiliation: Department of Preventive Medicine and Epidemiology, Loyola University Medical Center, Maywood, Illinois 60153, USA. hkramer@lumc.edu
authors.forename: Holly
authors.initials: H
authors.lastname: Kramer
authors.forename: Amy
authors.initials: A
authors.lastname: Luke
mesh_terms: D002908:Chronic Disease; D004813:Epidemiology / Q000639:trends; D014943:Global Health; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D009765:Obesity / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D006435:Renal Dialysis; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D015430:Weight Gain