Interventions for weight loss in people with chronic kidney disease who are overweight or obese.Conley, M. M., et al.
Cochrane Database of Systematic Reviews 2021; 3(3): CD013119.
The aim of this study was to assess the efficacy and safety of weight loss interventions in overweight or obese patients with chronic kidney disease (CKD).
A literature search was conducted using the Cochrane Kidney and Transplant Specialised Register. Study selection and data extraction were carried out by two independent reviewers. The Cochrane risk of bias tool was used to assess the methodological quality of the included studies.
17 studies were included in the review.
The primary outcomes were all-cause mortality, anthropometric measures and cardiovascular events. The secondary outcomes included the assessment of clinical parameters, patient-centred outcomes, cost-effectiveness and economic analysis, and adverse events and potential harms.
This is a Cochrane systematic review of intentional weight loss interventions in overweight and obese adults with CKD. The report is thorough and detailed; the methods are robust and clear. The review searched multiple databases and included 17 randomised controlled trials (988 patients), which had varying levels of quality and detail. Across the studies, there were many missing parameters that made some comparators difficult to assess and the evidence was of overall low quality. The authors divided the studies into 3 broad categories: any intervention versus usual care, any intervention versus dietary intervention, surgical intervention versus non-surgical intervention. This made strong conclusions difficult as there few studies making each specified comparison. Surgical interventions probably reduced body weight, but this is based on only 2 studies. Non-surgical interventions probably reduced body weight, based on several studies, and there was no difference between dietary-only interventions and lifestyle/pharmacological interventions. Across all intervention types, there is uncertainty about the impact on cardiovascular events and death.