Feasibility of the Comprehensive Overweight/Obesity Management Pre-Kidney Transplant Program: A Group-Based Lifestyle Intervention and GLP-1 Receptor Agonist Therapy for End-Stage Kidney Disease Candidates Ineligible Due to Obesity.

PURPOSE: The purpose of this study was to evaluate the feasibility of applying a structured interprofessional weight-loss intervention to improve transplant eligibility among candidates with body mass index (BMI) >35 kg/m².

METHODS

The Comprehensive Overweight/Obesity Management Pre-Kidney Transplant (COMPKT) program was a single-arm feasibility study at an academic center. Participants attended 15 weekly virtual group education sessions using the National Diabetes Prevention Program PreventT2 curriculum delivered by trained lifestyle coaches, with remote monitoring and interprofessional pharmacotherapy management including glucagon-like peptide-1 (GLP-1) receptor agonist or GLP-1/glucose-dependent insulinotropic polypeptide co-agonist therapy when clinically appropriate. Feasibility outcomes were enrollment, attendance, and GLP-1 uptake; clinical outcomes were BMI and percentage weight change.

RESULTS

Twenty-nine participants from the first 3 cohorts (median baseline BMI 41.1 kg/m²; interquartile range 40.4-44.8) were analyzed. Attendance varied: 44.8% attended < 50% of sessions, 20.7% attended 50% to 75%, and 34.5% attended > 75%. GLP-1 therapy use rose from 62.1% at baseline to 72.4% at session 15, with 52.4% reaching high-dose therapy. Median weight change was -3.44% (range -10.89% to +1.91%). Participants attending ≥ 50% of sessions had greater median weight loss than those with lower attendance, independent of GLP-1 use. Two participants received kidney transplants during the evaluation period.

CONCLUSIONS

COMPKT was feasible and produced modest but clinically meaningful weight loss in a high-risk population. Session engagement, rather than GLP-1 pharmacotherapy alone, appeared to drive outcomes, informing future program design and implementation.