# Obesity and Its Clinical Implications in End-Stage Kidney Disease

## TL;DR

This review explores how obesity affects patients with end-stage kidney disease and outlines strategies for better management and treatment.

## Contribution

The paper provides a comprehensive overview of the complex relationship between obesity and end-stage kidney disease, emphasizing personalized care strategies.

## Key findings

- Obesity is common in dialysis patients and poses challenges in treatment and outcomes.
- Bariatric surgery, especially sleeve gastrectomy, can improve transplant eligibility and reduce complications.
- Weight-loss medications are under-researched in ESKD but may be preferred over surgery after transplantation.

## Abstract

Both obesity and chronic kidney disease (CKD) are increasingly recognized as global epidemics. Their escalating incidence and far-reaching health implications highlight the urgent need for comprehensive prevention and management strategies. This review aims to clarify how obesity interacts with end-stage kidney disease (ESKD) and how to improve the management of obese patients receiving kidney replacement therapy. It also explores underlying mechanisms, current treatments, future directions, and ongoing controversies. By highlighting this intricate relationship, the review seeks to enhance clinical practice and promote further research toward more personalized care for this vulnerable population. Obesity is frequent in dialysis patients and creates challenges related to body composition, metabolism, and treatment. While higher body mass index (BMI) may appear to improve survival, this paradox does not offset the cardiovascular and functional risks of visceral and sarcopenic obesity. Obesity also increases post-transplant complications and can limit access to transplantation. Lifestyle changes rarely achieve lasting weight loss, whereas bariatric surgery—especially sleeve gastrectomy—can improve transplant eligibility with fewer complications. Weight-loss medications may be used before transplantation but remain insufficiently studied in ESKD. After transplantation, weight-reduction efforts should continue, with pharmacotherapy preferred over bariatric surgery. Comprehensive assessment strategies and individualized management approaches in ESKD patients are essential to optimize outcomes in this growing patient population.