Did you know that KDIGO released new clinical practice guidelines for the evaluation and management of CKD in March?
Well, if you are working as an RD in Renal and want to avoid reading the whole 199 pages just to find out if there is anything in your practice that needs updating, keep reading.
In the next few posts, I will be summarizing the key points from this guideline related to nutrition care. With a few comments/two cents of my own thrown in for good measure.
Practice Point 3.2.2.4: Physicians should consider advising/encouraging people with obesity and CKD to lose weight.
The KDIGO working group highlights the association of BMI above 25 and chronic disease risk. They also highlight the association with adiposity and CKD and suggest that the relationship appears to be causal.
There are no further directions provided in the guidelines on how to help someone living with CKD lose weight. I find this is recommendation disappointing. It advises telling people to lose weight without making recommendations on how to help patients’ achieve this.
The KDIGO statement contradicts the Obesity Canada Guidelines which recommends “Nutrition interventions for obesity management should focus on achieving health outcomes for chronic disease risk reduction and quality of life improvements, not just weight changes.”
From a practical prescription, I am also concerned about how to translate this practice point into recommendations about what to eat. Especially if I am also recommending:
- Lower protein intake
- Reduced sodium intake
- Add on any recommendations regarding potassium and phosphorus
- Prevent malnutrition
That calorie restriction may result in malnutrition is mentioned in the protein section of the KDIGO guidelines. How can a clinician successfully translate all of these recommendations into a diet that a patient can follow? Honestly, I am not sure.
Take Aways
According to the 2024 KDIGO guidelines, patients with a BMI above 25 should be advised to lose weight. The guidelines do not review what actions patients should to take to lose weight. As a clinician, I think successfully combining calorie restriction, with protein and sodium +/- potassium and phosphorus restrictions while maintaining lean muscle mass is going to be a significant barrier to the implementation of this practice point.
2 thoughts on “Should adults with CKD and a high BMI be advised to lose weight?”