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Q+A: New Study Reveals Insights into Healthy and Unhealthy Weight Loss Patterns for Adults with Obesity and Kidney Disease

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For people with chronic kidney disease, obesity can increase risks of kidney function decline and is associated with worse outcomes after kidney transplant surgery. But weight loss attempts must be managed with care to avoid other negative health consequences, such as malnutrition or low muscle mass. A new paper in Kidney International Reports from Drexel University researchers looks at three metrics — systolic blood pressure, albumin (protein made by the liver), and fat-free mass (everything other than fat in the body, including organs, bones, connective tissue, etc.) – to determine which markers give the best insights to clinical teams tasked with helping patients lose weight safely.

The team found that patients who experienced rapid drops in body mass index alongside drops in albumin or fat-free mass were at higher risk of death than patients who experienced slower weight loss. A weight loss pattern with increases in blood pressure and decreases in albumin was linked to an almost threefold higher risk of death compared to a pattern of slower weight loss, increase in albumin and decline in blood pressure.

On an encouraging note, they found that declining body mass index with a stable fat-free mass was associated with lower death risk than body mass index loss with short term or sustained fat-free mass loss.

Drexel News Blog checked in with the paper’s lead author Meera N. Harhay, MD, an associate professor in Drexel’s College of Medicine, about the implications of the findings for chronic kidney disease (CKD) patients.

Please tell us about this study. What did you find out?

People with obesity are often told to lose weight, but not all weight loss is created equal when it comes to health benefits and risks. We wanted to understand more about healthy and high-risk weight loss among adults with kidney disease and obesity. We found that there was more than one pattern of weight loss among individuals in our study. The patterns in which weight loss was rapid, and accompanied by markers of protein malnutrition or lower muscle mass were associated with the highest risk of death in this population.

What’s the main takeaway for clinical teams?

The main message is that weight loss can mean more than one thing. It’s important for us to look for other clues about how a person is doing nutritionally, and what their body composition tells us if the changes are healthy or not.

What’s the main takeaway for CKD patients, especially those bombarded with mixed messages about how important weight loss is?

CKD patients with obesity may be advised or desire to lose weight for so many valid reasons. Weight loss might help some people slow the progression of their kidney disease or improve other medical problems, like diabetes. Weight loss can help with mobility, too, helping people be more active which is so protective. But people should take care about how rapidly they lose weight – our study suggests that slow and steady might be safest – and focus on maintaining their nutrition and lean body mass as best they can while losing weight.

Can you describe the importance of hemodynamic, nutritional and body composition trajectories for patients with obesity and CKD? 

Our hypothesis was that healthy weight loss would be accompanied by good changes in blood pressure, nutrition, and lean body mass, and that the opposite would be true for high-risk weight loss. So, the trajectories of these other variables can give us clues about whether weight loss is healthy, or not.

Harhay and her co-authors say the findings are a reminder of the importance of optimal nutrition, but also exercise, in helping patients manage their disease.

“Physical activity for people with CKD and obesity is a safe and recommended therapy,” said Brandy-Joe Milliron, PhD, a co-author and associate professor in the College of Nursing and Health Professions. “Not only can exercise prevent fat free mass loss in these individuals, but it has also been linked to improvements in quality of life and cardiovascular health, among many other benefits.”

Harhay and colleagues also recently published a related paper in the journal AJKD, in which they surveyed 40 adult end-stage kidney disease (ESKD) patients with obesity (BMI >30 kg/m2) who were currently on dialysis about their experiences with obesity and weight loss, and 20 health professionals about their care for ESKD patients and found communication breakdowns and communications-based challenges that can prevent patients from learning how to lose the weight they need before eligibility for a life-saving transplant. Read more on that study at the Drexel News Bloghere.

Reporters interested in speaking with Harhay should contact Greg Richter, assistant director of News & Media Relations, or 215.895.2614.

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