Addressing the treatment gap at the intersection of Chronic Kidney Disease and obesity
By Ann Lambert
Imagine a situation where people affected by a disease can’t receive optimal care because of their weight.
For some people with Chronic Kidney Disease (CKD), who have above average rates of obesity, this is a reality.
Through her research into the overlap of CKD and obesity, Gurleen Sahi, a third-year medical student at Schulich School of Medicine & Dentistry, wants to help these patients get the care they need.
“The prevalence of chronic health conditions is growing, and people who live with multiple diseases including obesity and CKD face many barriers to optimal treatment,” said Sahi. “We need more tailored interventions for them.”
“The population that suffers from these chronic health conditions is growing, and often faces barriers to receiving appropriate treatment. We need more tailored interventions for them.”
– Gurleen Sahi, MD ’25 candidate
CKD is a condition that affects millions of people worldwide. It causes kidneys to gradually lose their ability to filter waste and fluid from the blood. Approximately 40 per cent of people living with CKD are classified as obese based on their body mass index (BMI, a common tool to measure obesity), Sahi said. In comparison, about 30 per cent of the Canadian adult population was classified as obese by BMI in 2022. CKD progresses faster in patients with obesity, putting them at risk of end-staged kidney disease. However, because of their obesity, they’re less likely to qualify for one of the ideal treatments - a kidney transplant. This is because obesity may be a risk factor for peri-transplant morbidity.
“There are also unique challenges with assisting people with CKD and obesity with weight loss,” Sahi added. “Our goal was to use administrative health data to define the severity of the problem in Canada, and highlight some of the characteristics of people living with high BMI and CKD (e.g. medical conditions, socioeconomic barriers). We hope that this understanding will assist with us trying to help patients lose weight to facilitate a transplant.”
Her research is part of a program called Obesity management for Kidney TRANSPLANTation, or OK-TRANSPLANT. The program, led by Dr. Kristin Clemens and Dr. Louise Moist, is to develop appropriate, accessible and patient-centred interventions to help people with CKD lose weight.
According to her supervisor, Clemens, associate professor in the Departments of Medicine (Endocrinology and Metabolism) and Epidemiology and Biostatistics at Schulich School of Medicine & Dentistry, Senior Adjunct ICES Scientist and Site Director of ICES Western, Sahi’s research will be crucial in the development of new strategies to help people lose weight in a healthy manner.
“This work has not only helped us understand some of the unique characteristics of people living with both a high BMI and CKD,” said Clemens, who is also the Diabetes Canada Chair in Diabetes Management, “but it will assist with our understanding of how many patients could be eligible for a large, randomized, controlled trial of a weight loss intervention focused upon supporting people with CKD.”
For instance, Sahi’s research found that CKD patients with a high BMI often come from lower income groups. This provides clinicians and researchers with a better understanding of the need for realistic interventions to support weight loss, instead of offering solutions that aren’t feasible within their socioeconomic context.
With help from the demographic context provided by Sahi’s research, the OK-TRANSPLANT team is actively developing weight-loss strategies that include diet, exercise and medication regimens tailored to the needs of this unique patient population.
After participating in the two-year Summer Research Training Program (SRTP) at Schulich Medicine & Dentistry, Sahi received the opportunity to present her findings at the National Kidney Foundation Spring Clinical Meeting in Long Beach, California this summer.
“I knew right away that she was destined for this work,” said Clemens, recalling the first time they met in Sahi’s first year of medical school. “She is astute, hardworking [and] has a knack for epidemiological research. I am extremely proud to have supervised her.”
From the moment Sahi learned about this project, she was excited about the opportunity to make a positive impact with her research. She has long been passionate about science and helping other people.
“I always wanted to pursue medicine from a very young age,” said Sahi, who grew up in both Vaughan and Brampton, Ont. After setting her sights on that goal, she couldn’t picture herself doing anything else.
