{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T12:38:26Z","timestamp":1786451906735,"version":"build-2736575974"},"reference-count":13,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"unspecified","delay-in-days":10,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100013528","name":"Diabetes Canada","doi-asserted-by":"publisher","award":["NA"],"award-info":[{"award-number":["NA"]}],"id":[{"id":"10.13039\/100013528","id-type":"DOI","asserted-by":"publisher"}]},{"name":"ACT Consortium","award":["NA"],"award-info":[{"award-number":["NA"]}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["NA"],"award-info":[{"award-number":["NA"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,7,23]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Large randomised controlled trials (RCTs) of obesity interventions have excluded those with advanced chronic kidney disease (CKD) including recipients of dialysis. Obesity management is critically important to their health and healthcare, including their ability to access kidney transplant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To describe the vanguard phase of a large, pragmatic, open-label RCT testing the effectiveness of a multi-component weight management programme vs standard of obesity care in advanced CKD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We are conducting an open-label RCT evaluating a 26-week multicomponent weight management programme (inclusive of monthly virtual coaching; semaglutide to a maximum dose of 2.0\u2009mg\/week; and behavioural, dietary and exercise counselling) for those with advanced CKD. Adults aged 18 years or older with a body mass index \u226535\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      with or without diabetes, who are receiving dialysis or have &gt;10%\u2009risk of end-stage kidney disease requiring renal replacement therapy over 2 years (based on the Kidney Failure Risk Equation) are included. Our primary success criterion is the recruitment of at least 50 participants (83% of target) within 12 months of site initiation Feasibility, adherence, safety and selected efficacy outcomes will be summarised descriptively. The acceptability of the intervention will be explored using qualitative methods. The study was initiated in September 2024 with a target completion date of December 2027.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT06396416\">NCT06396416<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-120427","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T12:06:23Z","timestamp":1786449983000},"page":"e120427","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Obesity management for kidney TRANSPLANTation: protocol for the vanguard phase of an innovative randomised controlled trial, embedded in routine care (OK-TRANSPLANT 2)"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct06396416","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9636-5597","authenticated-orcid":false,"given":"Kristin K","family":"Clemens","sequence":"first","affiliation":[{"name":"Schulich School of Medicine, Western University, London, Ontario, Canada"},{"name":"Endocrinology and Metabolism, Western University, London, Ontario, Canada"},{"name":"Epidemiology and Biostatistics, Western University, London, Ontario, Canada"},{"name":"Lawson Research Institute, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Irwin","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Western University, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Chiu","sequence":"additional","affiliation":[{"name":"London Health Sciences Centre, London, Ontario, Canada"},{"name":"Nephrology, Western University, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Dixon","sequence":"additional","affiliation":[{"name":"Schulich School of Medicine, Western University, London, Ontario, Canada"},{"name":"Epidemiology and Biostatistics, Western University, London, Ontario, Canada"},{"name":"London Health Sciences Centre Research Institute, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie J","family":"Bendo","sequence":"additional","affiliation":[{"name":"Lawson Research Institute, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phil","family":"Varughese","sequence":"additional","affiliation":[{"name":"Lawson Research Institute, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda J","family":"Vinson","sequence":"additional","affiliation":[{"name":"Nephrology, Dalhousie University, Halifax, Nova Scotia, Canada"},{"name":"Kidney Research Unit Nova Scotia, Halifax, Nova Scotia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"Lapier","sequence":"additional","affiliation":[{"name":"Lawson Research Institute, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Attalla","sequence":"additional","affiliation":[{"name":"York Weight Loss Clinic, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaclyn","family":"Ernst","sequence":"additional","affiliation":[{"name":"Schulich School of Medicine, Western University, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tayyab","family":"Khan","sequence":"additional","affiliation":[{"name":"Schulich School of Medicine, Western University, London, Ontario, Canada"},{"name":"Endocrinology and Metabolism, Western University, London, Ontario, Canada"},{"name":"Centre for Diabetes, Endocrinology and Metabolism, St Joseph\u2019s Health Care London, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann","family":"Young","sequence":"additional","affiliation":[{"name":"Nephrology, Unity Health Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Yau","sequence":"additional","affiliation":[{"name":"Nephrology, University Health Network, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Craig","sequence":"additional","affiliation":[{"name":"London Health Sciences Centre, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonja","family":"Reichert","sequence":"additional","affiliation":[{"name":"Schulich School of Medicine, Western University, London, 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