Perspectives on the profiling of renal risk in obesity

With the formal designation of obesity as a primary disease process, early detection of its end-organ consequences and the prognostication of long-term risk will become an important aspect of its clinical management. Obesity is increasingly recognized as a treatable risk factor for chronic kidney disease. However, profiling of kidney health and estimation of renal risk remain relatively underemphasized in obesity and nephrology care guidelines. The establishment of clinical protocols that facilitate the detection of early-stage renal impairment in obesity and incorporate profiling of an individual's risk of progression, could help guide strategies to break the causal association between obesity and chronic kidney disease. Currently, checks on kidney health in patients with obesity are prompted due to the presence of obesity complications such as cardiovascular and/or metabolic disease and routine screening relies upon the use of estimated glomerular filtration rate equations. Ample evidence exists to demonstrate that these equations are of limited utility in the setting of excess body weight and intentional weight loss. The present article presents the case that an expanded model of renal risk profiling should be developed for obesity medicine, suggesting feasible means of incorporating important risk factors and biomarker profiling alongside a more targeted assessment of directly measured GFR and renal functional reserve in at risk patients. The development of such a model or variation thereof should be prioritized to guide the targeted deployment of obesity treatments with proven reno-protective effects.