# Identifying Healthy and High-Risk Weight Loss Phenotypes to Optimize Obesity Management in End Stage Kidney Disease

> **NIH NIH R01** · DREXEL UNIVERSITY · 2021 · $291,877

## Abstract

Project Summary/Abstract
 In 2016, 47,000 individuals who initiated dialysis in the United States (~42% of all incident dialysis
patients that year) had obesity, with a body mass index (BMI) of ≥ 30 kilograms per meters squared. Across
the BMI spectrum, individuals with kidney disease commonly lose weight after initiating dialysis treatment.
However, whereas body weight typically stabilizes after the first several months of dialysis among patients
without obesity, those with obesity often continue to lose weight. Both people with and without obesity who are
on dialysis may lose weight due to muscle wasting and malnutrition, and recent studies have identified weight
loss as a risk factor for death among people on dialysis, independent of BMI. Yet, some of the weight loss
observed among obese dialysis patients may also reflect deliberate attempts to improve health, mobility, or
access to kidney transplantation. Currently, there are no guidelines to help clinicians to differentiate between
healthy and high-risk weight loss among people with obesity on dialysis. Further, typical obesity management
paradigms are not easily transferrable to obese people with end-stage kidney disease, given factors such as
chronic malnutrition, inflammation, and sarcopenia in this population that may modify the risks and benefits of
different weight loss strategies. Therefore, the overarching goal of this five-year research proposal is to define
healthy and high-risk weight loss phenotypes among people with obesity who are on dialysis, and to provide
clinically feasible tools to improve obesity management in the setting of end-stage kidney disease. We will
accomplish this goal by conducting three distinct but interrelated studies. In the first study, we will qualitatively
determine patient-prioritized endpoints of weight loss, in addition to patient, physician and other stakeholder
perspectives on the key factors that differentiate healthy from high-risk weight loss on dialysis. In the second
study, we will leverage a national dataset of 23,000 obese dialysis patients and apply constructs of high and
low physiologic reserve to derive healthy and high-risk weight loss phenotypes. We will then develop a weight-
loss risk calculator tool that predicts the risks of hospitalization and death that are associated with each weight
loss phenotype, using dynamic predictive joint models and machine learning techniques. In the third study, we
will enroll 250 obese dialysis patients in a prospective, longitudinal study across five regions in the United
States to evaluate the association between nutritional, inflammatory, and hemodynamic biomarkers and
measures of health trajectory that are not typically captured in registry data, such as sarcopenia, dynapenia,
body composition, and patient-prioritized endpoints such as quality of life. In accomplishing its aims, this
research will provide urgently needed knowledge and tools that will improve the medical management of tens
of thousan...

## Key facts

- **NIH application ID:** 10179372
- **Project number:** 5R01DK124388-02
- **Recipient organization:** DREXEL UNIVERSITY
- **Principal Investigator:** Meera Nair Harhay
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $291,877
- **Award type:** 5
- **Project period:** 2020-06-01 → 2025-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10179372

## Citation

> US National Institutes of Health, RePORTER application 10179372, Identifying Healthy and High-Risk Weight Loss Phenotypes to Optimize Obesity Management in End Stage Kidney Disease (5R01DK124388-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10179372. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*