Obesity in work-up of kidney transplant candidates – review of clinical practice guidelines

Background: Incidence of morbid obesity is rising worldwide. Current clinical practice guidelines for the pre-transplant evaluation of end-stage kidney disease (ESKD) patients lack clear recommendations on morbid obesity. Material and methods: The aim of this review was to summarize the current guidelines on the role and treatment of obesity in kidney transplant recipients. Eight current national and international clinical practice guidelines were identified in a comprehensive literature search. Results: All guidelines underline early detection of obesity and obesity-related comorbidities in ESKD patients. Only two guidelines explored the role of weight-loss surgery, however due to the lack of sufficient evidence no formal recommendation of surgical procedure was given. Conclusions: Diagnosis and treatment of obesity remains underappreciated in the current guidelines, most of which do not include pharmacological and surgical interventions. High-quality evidence is warranted to assess the role of weight-loss including surgery in ESKD patients and to update the recommendations in future guidelines.