Diabetes Obes Metab. 2026 Jun 22. doi: 10.1111/dom.70997. Online ahead of print.
ABSTRACT
BACKGROUND AND AIMS: Obesity and chronic kidney disease (CKD) are highly prevalent conditions with substantial public health impacts; their co-existence is common and associated with an aggravated risk for adverse outcomes. We conducted an updated systematic review and meta-analysis to evaluate the effects of weight-loss interventions on kidney, cardiometabolic and anthropometric outcomes in overweight or obese adults with CKD.
MATERIALS AND METHODS: Systematic searches in PubMed, CENTRAL and Embase databases were performed up to August 2025. Randomised-controlled trials evaluating the effects of any weight-loss interventions (lifestyle, pharmacological, surgical approaches) in overweight or obese patients with any stage of CKD were included. Primary endpoints were kidney and cardiovascular outcomes and mortality; secondary endpoints included anthropometric parameters and blood pressure (BP).
RESULTS: Forty-two studies (n = 11 017) were included in qualitative and 27 (n = 7015) in quantitative analysis. Cardiovascular outcomes and mortality data were lacking. The estimated glomerular filtration rate (eGFR) demonstrated a non-significant upward trend following lifestyle and pharmacological interventions (incretin-based therapies) and a significant increase following bariatric surgery (MD: 6.09 mL/min/1.73 m2;95% CI: [3.66, 8.52], I2 = 1%). Incretin-based therapies achieved a 41% reduction in urine albumin-to-creatinine ratio compared with placebo (95% CI: [29%, 52%], I2 = 86%). Anthropometric parameters, including weight, body-mass index and waist circumference, improved across all intervention categories, with lifestyle-based approaches most extensively studied (weight-loss MD: -4.13 kg; 95% CI:[-6.49, -1.76], I2 = 83%). Systolic and diastolic BP showed modest, non-significant reductions following lifestyle interventions (SBP MD: -3.10 mm Hg; 95% CI: [-7.59, 1.38], I2 = 45%), while data for pharmacological and surgical approaches were limited and definitive conclusions cannot be made.
CONCLUSIONS: In CKD patients with overweight or obesity, all types of interventions (lifestyle, pharmacological, surgical) are effective for weight-loss. Incretin-based therapies confer additional nephroprotective effects by significantly reducing albuminuria. Uncertainty persists for the remaining outcomes, highlighting the need for additional research.
PMID:42331714 | DOI:10.1111/dom.70997