Christopher H. Grant, Samira Bell
More than half of adults are overweight/obese and one in 10 has chronic kidney disease (CKD). These patients are at high risk of cardiovascular morbidity and mortality. This review discusses the pathophysiology, epidemiology, therapeutic principles and challenges of obesity management in adults with non-dialysis-dependent CKD. Inflammation, metabolic dysfunction and neurohormonal changes are central processes in the development of obesity-associated kidney disease. Obesity with metabolic syndrome is a risk factor for de novo CKD, progression to end-stage kidney disease and cardiovascular death. Treatment options to address obesity and related sequelae include lifestyle interventions, such as dietary modification and exercise therapy, drug treatment, such as glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter inhibitors, and metabolic surgery, such as vertical sleeve gastrectomy, Roux-en-Y gastric bypass or gastric banding. Challenges of management include fragmented care, limited evidence and the obesogenic environment. Cardiologists and nephrologists should work collaboratively to proactively screen for and manage cardiorenal risk in obese adults with CKD to mitigate avoidable harm.