Abstract
RATIONALE & OBJECTIVE: Obesity is associated with morbidity and mortality in people with chronic kidney disease (CKD). Identifying safe and effective nonpharmacologic and nonsurgical interventions to achieve a healthier body weight is essential. STUDY DESIGN: Scoping review of observational studies and randomized control trials. SETTING & STUDY POPULATIONS: Adults aged ≥18 years with a body mass index (BMI) ≥30 kg/m(2) and advanced CKD (category G3-G5D). SELECTION CRITERIA FOR STUDIES: Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews (PRISMA-ScR), we systematically searched 2 electronic databases (MEDLINE and Embase) for studies that examined the effect of nonpharmacologic and nonsurgical interventions for weight loss between January 2010-July 2024. Outcomes included weight loss and BMI. We also examined adherence, whether participants were involved in the design of the study, and adverse events. DATA EXTRACTION: Two reviewers screened relevant citations and extracted study characteristics and outcomes. Discrepancies were resolved by a third reviewer. ANALYTICAL APPROACH: Study data were summarized descriptively following guidance from the PRISMA-ScR. RESULTS: Of the 2,453 citations, 17 met inclusion criteria (9 randomized controlled trials, 2 nonrandomized trials, 5 prospective cohort studies, and 1 retrospective cohort study) and included a total of 960 participants. Interventions included exercise programs, dietary therapy, and/or cognitive behavioral therapy with follow-up ranging from 3-12 months. It appeared that dietary intervention that promoted significant caloric restriction over the short term led to the most weight loss (average, 7 kg). Interventions with monitored coaching appeared helpful. No adverse events were reported. None of the studies involved participants as partners. LIMITATIONS: Not all studies included participants' estimated glomerular filtration rate or BMI category, and we may have included some without severe CKD or BMI ≥30 kg/m(2). CONCLUSIONS: Programs encouraging very low-energy diets along with monitored coaching, may result in modest short-term weight loss. Patient views on these programs and their longer term success remain unclear.