Effects of Weight-Loss Interventions on Kidney, Cardiometabolic and Anthropometric Outcomes in Adults With CKD and Overweight or Obesity: A Systematic Review and Meta-Analysis.

Abstract

Obesity and chronic kidney disease (CKD) are highly prevalent conditions with substantial public health impacts; their co-existence is common and associated with an aggravated risk for adverse outcomes. We conducted an updated systematic review and meta-analysis to evaluate the effects of weight-loss interventions on kidney, cardiometabolic and anthropometric outcomes in overweight or obese adults with CKD. Systematic searches in PubMed, CENTRAL and Embase databases were performed up to August 2025. Randomised-controlled trials evaluating the effects of any weight-loss interventions (lifestyle, pharmacological, surgical approaches) in overweight or obese patients with any stage of CKD were included. Primary endpoints were kidney and cardiovascular outcomes and mortality; secondary endpoints included anthropometric parameters and blood pressure (BP). Forty-two studies (n = 11 017) were included in qualitative and 27 (n = 7015) in quantitative analysis. Cardiovascular outcomes and mortality data were lacking. The estimated glomerular filtration rate (eGFR) demonstrated a non-significant upward trend following lifestyle and pharmacological interventions (incretin-based therapies) and a significant increase following bariatric surgery (MD: 6.09 mL/min/1.73 m²;95% CI: [3.66, 8.52], I² = 1%). Incretin-based therapies achieved a 41% reduction in urine albumin-to-creatinine ratio compared with placebo (95% CI: [29%, 52%], I² = 86%). Anthropometric parameters, including weight, body-mass index and waist circumference, improved across all intervention categories, with lifestyle-based approaches most extensively studied (weight-loss MD: -4.13 kg; 95% CI:[-6.49, -1.76], I² = 83%). Systolic and diastolic BP showed modest, non-significant reductions following lifestyle interventions (SBP MD: -3.10 mm Hg; 95% CI: [-7.59, 1.38], I² = 45%), while data for pharmacological and surgical approaches were limited and definitive conclusions cannot be made. In CKD patients with overweight or obesity, all types of interventions (lifestyle, pharmacological, surgical) are effective for weight-loss. Incretin-based therapies confer additional nephroprotective effects by significantly reducing albuminuria. Uncertainty persists for the remaining outcomes, highlighting the need for additional research.