Nonrandomized trial of weight loss with orlistat, nutrition education, diet, and exercise in obese patients with CKD: 2-year follow-up.
BACKGROUND
Obesity increases the comorbidity-adjusted relative risk of developing end-stage renal disease. Body mass index (BMI) > 30 kg/m(2) was a contraindication for transplant in our renal unit until 2008.


METHODS
Open-label prospective nonrandomized intervention.


METHODS
All men and women aged 18-75 years with chronic kidney disease (CKD) and BMI > 30 or > 28 kg/m(2) with diabetes, hypertension, or dyslipidemia and otherwise suitable for kidney transplant if on dialysis therapy were eligible to enroll in the weight-management program. 64 patients were referred; 44 agreed to participate in the intervention group and 20 did not wish to take part and constitute the usual-care group.


METHODS
24-month weight-management program that included a low-fat renal-specific diet, exercise, and orlistat, 120 mg, 3 times daily.


RESULTS
Body weight, blood pressure (BP), kidney transplant wait listing.


METHODS
Body weight, BP, estimated glomerular filtration rate (eGFR; calculated using the 4-variable Modification of Diet in Renal Disease [MDRD] Study equation).


RESULTS
32 patients (73%) in the weight-management program group completed the follow-up evaluation. Baseline mean BMI was 35.7 +/- 4.5 (SD) kg/m(2) in the weight-management program group and 34.1 +/- 4.2 kg/m(2) in the usual-care group. 12 (38%) patients in the weight-management program and 9 (45%) in usual care had stages 3-4 CKD, with the remainder in stage 5 CKD on dialysis therapy. There were no differences in body weight, BP, or eGFR between groups at baseline. After 24 months, mean body weight was 94.6 +/- 16.1 kg in the weight-management program group versus 101.0 +/- 26.8 kg in the usual-care group (P < 0.001), and eGFR was 43 mL/min in the weight-management program group versus 18 mL/min in the usual-care group (P < 0.001). 9 of 26 (35%) otherwise eligible patients in the weight-management program and 1 of 18 (6%) patients in usual care were accepted for kidney transplant listing, with 3 transplants performed in the weight-management program group and 1 in the usual-care group.


CONCLUSIONS
Nonrandomized trial, small number of participants.


CONCLUSIONS
The weight-management program group showed significant weight loss and weight-loss maintenance in obese patients with CKD and potentially enables obese patients with CKD to undergo kidney transplant.
MacLaughlin
Helen L
HL
Department of Nutrition and Dietetics, King's College Hospital, London SE5 9RS, UK. helen.maclaughlin@kch.nhs.uk
Cook
Sharlene A
SA
Kariyawasam
Deepa
D
Roseke
Magnus
M
van Niekerk
Marcelle
M
Macdougall
Iain C
IC
D000293:Adolescent; D000328:Adult; D000368:Aged; D019440:Anti-Obesity Agents / Q000008:administration & dosage / Q000627:therapeutic use; D015992:Body Mass Index; D004032:Diet / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D007783:Lactones / Q000008:administration & dosage / Q000627:therapeutic use*; D008049:Lipase / Q000037:antagonists & inhibitors; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D009765:Obesity / Q000150:complications / Q000628:therapy*; D000077403:Orlistat; D010353:Patient Education as Topic / Q000379:methods*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss; D055815:Young Adult
D019440:Anti-Obesity Agents; D007783:Lactones; D000077403:Orlistat; D008049:Lipase