Treating the obese dialysis patient: challenges and paradoxes.

Obesity is a major epidemic in the general population and has added unique challenges to renal replacement therapy as choice of access, dialysis adequacy, and preparation for kidney transplantation may all be affected. There are few clinical studies on managing obese patients with end-stage renal disease (ESRD) and no accepted strategies for the variety of problems encountered in this population. Attempts at weight loss are generally advisable to prevent obesity-related surgical complications and improve patient and graft survival after kidney transplantation. This article reviews the unique aspects of managing obese patients with ESRD.