A Modified Meal Replacement Plan As Weight Loss Treatment In Chronic Kidney Disease: A Case Study

Abstract

Low calorie liquid meal replacements can be used to achieve weight loss in obese patients. Many consider renal disease a contraindication to this due to a lack of specific research. The aim of this case study is to illustrate that this therapy can be used effectively in Chronic Kidney Disease (CKD). After numerous failed weight loss attempts, the multidisciplinary team (Nephrology, Endocrinology, General Practice and Dietetics) decided to trial a 65 year old patient (CKD Stage 3 secondary to Type 2 Diabetes Mellitus requiring insulin) on a modified meal replacement plan. This plan consisted of 3 Optifast meal replacement drinks plus one portion controlled meal, (4MJ and 85g of protein per day). Monitoring included frequent blood glucose self testing, fortnightly blood tests and review by the Dietitian (monthly once stable). The patient was initially unable to exercise due to pain. At baseline, weight was 157 kg (BMI: 41 kg/m2), waist circumference 155cm and blood biochemistry indicated CKD stage 3b (eGFR: 39 ml/min, Urea: 15.9 mmol/L, Creat: 156 umol/L). After 14 weeks weight had decreased 22 kg (BMI: 35.8 kg/m2), waist circumference had decreased 18 cm and reported pain improved. Insulin requirements approximately halved, and blood biochemistry (eGFR: 42 ml/min, Urea: 15.2 mmol/L, Creat: 147 umol/L) indicated no decline in renal function. With close monitoring a modified meal replacement plan was used successfully in a patient with CKD however prospective randomised trials are required to further investigate this treatment.