Nonrandomized Trial of Weight Loss With Orlistat, Nutrition Education, Diet, and Exercise in Obese Patients With CKD: 2-Year Follow-up
Received 10 February 2009; accepted 4 September 2009. published online 18 November 2009.
Background
Obesity increases the comorbidity-adjusted relative risk of developing end-stage renal disease. Body mass index (BMI) > 30 kg/m2 was a contraindication for transplant in our renal unit until 2008.
All men and women aged 18-75 years with chronic kidney disease (CKD) and BMI > 30 or > 28 kg/m2 with diabetes, hypertension, or dyslipidemia and otherwise suitable for kidney transplant if on dialysis therapy were eligible to enroll in the weight-management program. 64 patients were referred; 44 agreed to participate in the intervention group and 20 did not wish to take part and constitute the usual-care group.
Intervention
24-month weight-management program that included a low-fat renal-specific diet, exercise, and orlistat, 120 mg, 3 times daily.
Outcomes
Body weight, blood pressure (BP), kidney transplant wait listing.
Measurements
Body weight, BP, estimated glomerular filtration rate (eGFR; calculated using the 4-variable Modification of Diet in Renal Disease [MDRD] Study equation).
Results
32 patients (73%) in the weight-management program group completed the follow-up evaluation. Baseline mean BMI was 35.7 ± 4.5 (SD) kg/m2 in the weight-management program group and 34.1 ± 4.2 kg/m2 in the usual-care group. 12 (38%) patients in the weight-management program and 9 (45%) in usual care had stages 3-4 CKD, with the remainder in stage 5 CKD on dialysis therapy. There were no differences in body weight, BP, or eGFR between groups at baseline. After 24 months, mean body weight was 94.6 ± 16.1 kg in the weight-management program group versus 101.0 ± 26.8 kg in the usual-care group (P < 0.001), and eGFR was 43 mL/min in the weight-management program group versus 18 mL/min in the usual-care group (P < 0.001). 9 of 26 (35%) otherwise eligible patients in the weight-management program and 1 of 18 (6%) patients in usual care were accepted for kidney transplant listing, with 3 transplants performed in the weight-management program group and 1 in the usual-care group.
Limitations
Nonrandomized trial, small number of participants.
Conclusions
The weight-management program group showed significant weight loss and weight-loss maintenance in obese patients with CKD and potentially enables obese patients with CKD to undergo kidney transplant.
1Department of Nutrition and Dietetics, King's College Hospital, London, UK
2Department of Physiotherapy, King's College Hospital, London, UK
3Department of Renal Medicine, King's College Hospital, London, UK
Address correspondence to Helen MacLaughlin, BSc (Hons), Department of Nutrition and Dietetics, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
ABSTRACT