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Obesity, diet quality, and kidney disease

Prevalence of obesity has risen dramatically in the last few decades; more than 1 in 5 adults receiving primary care at Geisinger have severe obesity (body mass index  35 kg/m2). Severe obesity is a strong risk factor for CKD and ESRD. Bariatric surgery is increasingly being used across the country as a treatment for severe obesity, resulting in sustained weight loss, improved blood pressure and blood sugars. Current funded research efforts include examining the effect of bariatric surgery on long-term kidney outcomes. 

Diet quality is an important modifiable determinant of health, including CKD. A pilot research study, FITKIDNEY, aims to determine whether a remotely delivered intervention can result in sustained improvements in dietary quality among patients with early CKD. FITKIDNEY incorporates a free smartphone app to collect dietary data, a dietitian who provides personalized counseling via telephone, and an educational website. 

A specific nutrient of interest particularly relevant to CKD is dietary phosphorus. Current research efforts include investigating the health impacts of high dietary phosphorus as well as better understanding sources of dietary phosphorus in the diet.

Related publications

Dietary factors in kidney disease

Association of a reduction in central obesity and phosphorus intake with changes in urinary albumin excretion: the PREMIER study. 

Chang A, Batch BC, McGuire HL, Vollmer WM, Svetkey LP, Tyson CC, Sanguankeo A, Anderson C, Houston J, Appel LJ. 
American Journal of Kidney Disease. 2013 Nov;62(5):900-7.

High dietary phosphorus intake is associated with all-cause mortality: results from NHANES III.

Chang AR, Lazo M, Appel LJ, Gutiérrez OM, Grams ME. 
American Journal of Clinical Nutrition. 2014 Feb;99(2):320-7. 

Effects of a behavioral intervention that emphasizes spices and herbs on adherence to recommended sodium intake: results of the "SPICE" randomized clinical trial. 

Anderson CAM, Cobb LK, Miller ER, Woodward M, Hottenstein A, Chang AR, Mongraw-Chaffin M, White K, Charleston J, Tanaka T, Thomas L, Appel LJ.
American Journal of Clinical Nutrition. 2015 Sep;102(3):671-9. 

Phosphorus Additives and Albuminuria in Early Stages of CKD: A Randomized Controlled Trial. 

Chang AR, Miller ER 3rd, Anderson CA, Juraschek SP, Moser M, White K, Henry B, Krekel C, Oh S, Charleston J, Appel LJ. 
American Journal of Kidney Disease. 2017 Feb;69(2):200-209.

Dietary Phosphorus Intake and the Kidney.

Chang AR, Anderson C. 
Annual Review of Nutrition. 2017 Jun 14.

Morbid obesity, bariatric surgery and kidney function

Effect of Obesity and Metabolic Syndrome on Kidney Disease and the Progression to Chronic Renal Failure.

Chang A, Kramer H.  
In: Kopple JD, Massry SG, Kalantar-Zadeh K, editors.  
Nutritional Management of Renal Disease, Third Edition; 2012.

Lifestyle-related factors, obesity, and incident microalbuminuria: the CARDIA (Coronary Artery Risk Development in Young Adults) study. 

Chang A, Van Horn L, Jacobs DR Jr, Liu K, Muntner P, Newsome B, Shoham DA, Durazo-Arvizu R, Bibbins-Domingo K, Reis J, Kramer H.
American Journal of Kidney Disease. 2013 Aug;62(2):267-75. 

The effects of weight change on glomerular filtration rate.

Chang A, Greene TH, Wang X, Kendrick C, Kramer H, Wright J, Astor B, Shafi T, Toto R, Lewis J, Appel LJ, Grams M.
Nephrology Dialysis Transplantation. 2015 Jun 17.

Bariatric surgery is associated with improvement in kidney outcomes.

Chang AR, Chen Y, Still C, Wood GC, Kirchner HL, Lewis M, Kramer H, Hartle JE, Carey D, Appel LJ, Grams ME.
Kidney International. 2016 Jul;90(1):164-71. 

Bariatric Surgery and Kidney-Related Outcomes.

Chang AR, Grams ME, Navaneethan SD.
Kidney International Reports. 2017 Mar;2(2):261-270.