Obesity and nephrology: results of a knowledge and practice pattern survey

Background: Obesity, the largest epidemic of modern time, carries a markedly increased risk of type-2 diabetes, cancer, fatty liver, sleep apnea, hypertension, dyslipidemia and atherosclerotic cardiovascular disease. In addition, obesity increases the risk of chronic kidney disease (CKD) and its progression to end-stage renal disease (ESRD). There are limited data regarding the basic knowledge of nephrologists on how to assess and manage obesity in the setting of CKD.

Methods: To learn more about practice patterns among nephrologists, a survey on obesity was published online in NDT-Educational between 8 November 2012 and 31 January 2013. Three-hundred and ninety-nine responses were received mostly from nephrologists in Europe (57%), South and Central America (12%) and the Middle East (10%). The majority practiced in clinical nephrology (64%) and outpatient dialysis clinics (23%). Whereas 54% of the participants worked in hospitals, 31% worked in academic centers.

Results: Most participants stated that the number of obese patients has increased both among their CKD stage 2-5 patients and in their dialysis clinics during the last 10 years. For routine estimation of body fat content in the dialysis clinic, the majority of nephrologists (43%) still rely on the body mass index (BMI). A majority (72%) does not think that weight gain should be promoted in dialysis patients with a BMI of <35 kg/m(2). The survey also showed that 30% of the responders did not have any predetermined cut-off level for BMI. However, 29% used a cut-off level of 35 kg/m(2) and 27% used a cut-off level of 30 kg/m(2) for approval for kidney transplantation in their clinics.

Conclusions: The level of understanding of the intricacies of obesity in the setting of CKD needs improvement among nephrologists. Similarly, there is no consensus regarding weight management strategies in CKD patients with obesity. Studies are needed in this orphan area of renal research.