Efficacy and Safety of Medical Weight Loss Interventions in Patients with Advanced Chronic Kidney Disease

Objective:
The prevalence of obesity in patients with chronic kidney disease is higher than in general population. Obesity may limit accessibility to kidney transplantation, reduces quality of life and increases mortality rates, yet treatments for obesity are vastly underutilized in this population due to concerns related to feasibility and tolerability. This study aimed to evaluate the real-world efficacy and safety outcomes of medical weight loss therapies in patients with advanced chronic kidney disease.

Methods:
This is a retrospective analysis of all individuals with eGFR ≤30 mL/min/1.73m² referred to an academic medical weight management clinic from 01/2015 through 09/2022. We report body weight changes through 60 months of follow-up, treatment-related side effects and reasons for treatment discontinuation.

Results:
Overall 89 individuals met inclusion criteria, of which 16 individuals (average age 47.5±14.39 years, weight 114.1±24.27kg, 68.7% women, 75% on dialysis) were treated with intensive lifestyle modifications (ILM) alone and 73 individuals (average age 52.07±14.09 years, weight 120.3±21.63kg, 54.8% women, 53.4% on dialysis) were treated with anti-obesity medications (AOMs) along with ILM [all treated with a glucagon-like peptide-1 receptor agonist (GLP1-RA)+/-other AOMs]. Mean duration of follow-up was significantly longer in those treated with GLP1-RA compared to those treated with ILM: 1036.03±834.81 days versus 180.31±254.37 days, respectively, as such outcome data beyond 3 months of follow-up is only available for those treated with GLP1-RA. Percentage body weight change at 3 months was -0.83+/-11.6% for those treated with ILM and -4.03+/-5.4% for those treated with GLP1-RA (p=0.16 between groups). GLP1-RA group experienced the following percentage weight change from baseline: -5.1+/-6.3% at 6 months, -6.27+/-7.3% at 9 months, -6.44+/-7.8% at 12 months, -7.74+/-10.8% at 24 months, -9.38+/-13.8% at 36 months, -10.06+/-13.8% at 48 months and -7.19+/-14.6% at 60 months. At the time of data extraction 49.3% of patients were continuing treatment with GLP1-RA; 9.58% of individuals treated with GLP1-RA discontinued treatment due to gastrointestinal side effects, only one discontinued due to excessive weight loss. There were 3 events of pancreatitis in the GLP1-RA treated group and none in the ILM group. Of those treated with GLP1-RA, 21.91% reached the maximum dose licensed for obesity, 46.57% the maximum dose licensed for diabetes, and 31.51% were on lower doses.

Discussion/Conclusion:
Most patients with advanced chronic kidney disease referred to a weight management program were treated with GLP1-RA based AOMs. These agents successfully induced and maintained weight change over a long period of follow-up, with few experiencing side effects and very few having to discontinue treatment due to side effects.