Planning for renal replacement therapy in the patient with obesity

The last stages of chronic kidney disease (CKD) are known for anorexia, weight loss, nausea, and muscle wasting, yet obesity and morbid obesity are now frequently encountered at the initiation of dialysis or referral for kidney transplantation. This development is a relatively new phenomenon, and few evidence-based practices are available to guide the clinician. Recommendations are mostly based on extrapolation from the general population, personal experience, institutional protocols, or anecdotal reports in the literature. This article will briefly review the issues that surround planning for renal replacement therapy in the obese CKD patient.