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Nonrandomized trial of weight loss with orlistat, nutrition education, diet, and exercise in obese patients with CKD: 2-year follow-up.
Am J Kidney Dis. 2010 Jan; 55(1):69-76.AJ

Abstract

BACKGROUND

Obesity increases the comorbidity-adjusted relative risk of developing end-stage renal disease. Body mass index (BMI) > 30 kg/m(2) was a contraindication for transplant in our renal unit until 2008.

STUDY DESIGN

Open-label prospective nonrandomized intervention.

SETTING & PARTICIPANTS

All men and women aged 18-75 years with chronic kidney disease (CKD) and BMI > 30 or > 28 kg/m(2) 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/m(2) in the weight-management program group and 34.1 +/- 4.2 kg/m(2) 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.

Links

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Authors+Show Affiliations

MacLaughlin HL
Department of Nutrition and Dietetics, King's College Hospital, London SE5 9RS, UK. helen.maclaughlin@kch.nhs.uk
Cook SA
No affiliation info available
Kariyawasam D
No affiliation info available
Roseke M
No affiliation info available
van Niekerk M
No affiliation info available
Macdougall IC
No affiliation info available

MeSH

AdolescentAdultAgedAnti-Obesity AgentsBody Mass IndexDietDose-Response Relationship, DrugExercise TherapyFemaleFollow-Up StudiesGlomerular Filtration RateHumansKidney Failure, ChronicLactonesLipaseMaleMiddle AgedNutritional StatusObesityOrlistatPatient Education as TopicProspective StudiesTime FactorsTreatment OutcomeWeight LossYoung Adult

Pub Type(s)

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19926371

Clinical Trial Links

Efficacy and Tolerance of Liraglutide for Weight Loss in Obese Type 2 Diabetic Hemodialysis Patients

Citation

MacLaughlin, Helen L., et al. "Nonrandomized Trial of Weight Loss With Orlistat, Nutrition Education, Diet, and Exercise in Obese Patients With CKD: 2-year Follow-up." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 55, no. 1, 2010, pp. 69-76.
MacLaughlin HL, Cook SA, Kariyawasam D, et al. Nonrandomized trial of weight loss with orlistat, nutrition education, diet, and exercise in obese patients with CKD: 2-year follow-up. Am J Kidney Dis. 2010;55(1):69-76.
MacLaughlin, H. L., Cook, S. A., Kariyawasam, D., Roseke, M., van Niekerk, M., & Macdougall, I. C. (2010). Nonrandomized trial of weight loss with orlistat, nutrition education, diet, and exercise in obese patients with CKD: 2-year follow-up. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 55(1), 69-76. https://doi.org/10.1053/j.ajkd.2009.09.011
MacLaughlin HL, et al. Nonrandomized Trial of Weight Loss With Orlistat, Nutrition Education, Diet, and Exercise in Obese Patients With CKD: 2-year Follow-up. Am J Kidney Dis. 2010;55(1):69-76. PubMed PMID: 19926371.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nonrandomized trial of weight loss with orlistat, nutrition education, diet, and exercise in obese patients with CKD: 2-year follow-up. AU - MacLaughlin,Helen L, AU - Cook,Sharlene A, AU - Kariyawasam,Deepa, AU - Roseke,Magnus, AU - van Niekerk,Marcelle, AU - Macdougall,Iain C, Y1 - 2009/11/17/ PY - 2009/02/10/received PY - 2009/09/04/accepted PY - 2009/11/21/entrez PY - 2009/11/21/pubmed PY - 2010/2/3/medline SP - 69 EP - 76 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am. J. Kidney Dis. VL - 55 IS - 1 N2 - BACKGROUND: Obesity increases the comorbidity-adjusted relative risk of developing end-stage renal disease. Body mass index (BMI) > 30 kg/m(2) was a contraindication for transplant in our renal unit until 2008. STUDY DESIGN: Open-label prospective nonrandomized intervention. SETTING & PARTICIPANTS: All men and women aged 18-75 years with chronic kidney disease (CKD) and BMI > 30 or > 28 kg/m(2) 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/m(2) in the weight-management program group and 34.1 +/- 4.2 kg/m(2) 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. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/19926371/Nonrandomized_trial_of_weight_loss_with_orlistat_nutrition_education_diet_and_exercise_in_obese_patients_with_CKD:_2_year_follow_up_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(09)01260-8 DB - PRIME DP - Unbound Medicine ER -