Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

What is the comparative effectiveness of overweight prevention, weight maintenance and weight loss interventions in preventing chronic kidney disease (CKD) or slowing CKD progression?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

We are interested in any weight prevention/maintenance/loss interventions, including diet, exercise, behavioral, education, pharmaceuticals, or surgery. These may be compared to each other, and to no intervention.

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

We are interested in patients with or at risk for CKD, including adults, children, elderly, and overweight or obese.

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

African-Americans, and disparity populations with or at risk for CKD

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

We are interested in prevention of CKD in at risk populations, and treatment of CKD to stop or slow progression of the disease.

Describe any health-related risks, side effects, or harms that you are concerned about.

We are interested in any risks, side effects, or harms of the interventions, especially pharmaceuticals and surgery.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Obesity

AHRQ Priority Populations

• Low income groups
• Minority groups
• Women
• Children
• Elderly

Federal Health Care Program

• Medicaid
• Medicare
• State Children's Health Insurance Program (SCHIP)

Importance

Describe why this topic is important.

CKD is a significant public health problem affecting more than 30 million adults in the United States, who are at increased risk of hospitalization, cardiovascular disease, end-stage renal disease (ESRD), and death. Obesity, which affects nearly one third of US adults, is a risk factor for the development and progression of CKD. However, the effectiveness and comparative effectiveness of weight loss interventions in preventing and treating CKD is unclear.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

This topic was identified in our AHRQ/EHC sponsored topic identification project. Among a large number of CKD topics, a group of stakeholders ranked this as a high priority topic.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

Overweight and obesity are risk factors as well as comorbidities for CKD. It is currently not clear how much of an effect prevention and treatment of overweight and obesity has on prevention and progression of CKD, nor is it clear which weight interventions are most effective at controlling weight and impacting CKD.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

Convincing evidence on effective weight interventions will potentially change guidelines and practice.

Describe the timeframe in which an answer to your question is needed.

No particular timeframe, rather this is an ongoing and increasing problem for society.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

CKD has a higher prevalence among African Americans, Hispanics, and elderly people, disparity populations with poor access and underutilization, lower economic and educational status, and inner city and some rural populations. Overweight and obesity are also prevalent in these same populations.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

Convincing evidence on effective weight interventions will potentially change guidelines and practice.

Are you making a suggestion as an individual or on behalf of an organization?

Organization

Please tell us how you heard about the Effective Health Care Program