Summary of findings 1. Any weight loss intervention compared to usual care or control.

Any weight loss intervention versus usual care/control for weight loss in people with chronic kidney disease (CKD) who are overweight or obese
Patient or population: people with CKD who are overweight or obese Setting: various (hospital outpatient clinic, research organisation) Intervention: any weight loss intervention Comparison: usual care or control
Outcomes	Anticipated absolute effects* (95% CI)		Relative effect (95% CI)	No. of participants (studies)	Certainty of the evidence (GRADE)	Comments
	Risk with usual care/control	Risk with weight loss intervention
Death (any cause)	This outcome was not reported by any of the included studies	‐	‐	‐	‐	‐
Cardiovascular events	This outcome was not reported by any of the included studies	‐	‐	‐	‐	‐
Weight loss Follow up: range 5 weeks to 12 months	Mean weight loss ranged across control groups from 0.3 to 0.7 kg; mean post intervention body weight ranged from 86 to 136 kg The mean weight loss in the intervention group was 3.69 kg lower than the control group (5.82 lower to 1.57 lower)		‐	180 (6)	⊕⊝⊝⊝ VERY LOW 1 2 3 4	Majority of studies from lifestyle interventions No studies involving surgical interventions
Body mass index (BMI) Follow up: range 3 to 12 months	The mean BMI across control groups ranged from 28 to 38 kg/m² The mean BMI in the intervention group was 2.18 kg/m² lower than the control group (4.90 lower to 0.54 higher)		‐	100 (4)	⊕⊝⊝⊝ VERY LOW 1 2 3 4	All of studies from lifestyle interventions No studies involving pharmacological or surgical interventions
Waist circumference Follow up: range 3 to 12 months	The mean waist circumference across control groups ranged from 96 to 103 cm The mean weight circumference in the intervention group was 0.68 cm lower than the control group (7.6 lower to 6.24 higher)		‐	53 (2)	⊕⊝⊝⊝ VERY LOW 1 2 3 4	All of studies from lifestyle interventions No studies involving pharmacological or surgical interventions
Proteinuria Follow up: range 3 to 12 months	The mean proteinuria across control groups ranged from 0.5 to 3.5 g/day The mean proteinuria in the intervention group was 0.29 g/day lower than the control group (0.76 lower to 0.18 higher)		‐	84 (4)	⊕⊝⊝⊝ VERY LOW 1 2 3 4	All of studies from lifestyle interventions No studies involving pharmacological or surgical interventions
Systolic blood pressure (SBP) Follow up: range 3 to 6 months Diastolic blood pressure (DBP) Follow up: range 3 to 6 months	The mean SBP across control groups ranged from 123 to 140 mmHg The mean SBP in the intervention group was ‐3.45 mmHg lower than the control group (‐9.99 lower to 3.09 higher) The mean DBP across control groups ranged from 75 to 89 mmHg The mean DBP in the intervention group was ‐2.02 mmHg lower than the control group (‐3.79 lower to 0.24 higher)		‐	139 (4)	⊕⊝⊝⊝ VERY LOW 1 2 3 4	All of studies from lifestyle interventions No studies involving pharmacological or surgical interventions
CI: confidence interval; MD: mean difference
GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

¹ Evidence certainty downgraded one level for indirectness

² Evidence certainty downgraded one level for imprecision

³ Evidence certainty downgraded one level for uncertain or high risk of bias

⁴ Evidence certainty downgraded one level for moderate heterogeneity