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If they are not losing as much or having a lot of cravings, something like Contrave, Naltrexone or Topiramate could be added as standalone medications. However, if youve managed all the variables, are layering medications, and the patient is still not making sufficient progress, then a bariatric procedure should be part of the conversation

Unfortunately, while antidiabetics and antihyperlipidemic help in CKD management, they are excreted by the kidneys and have a high risk of drug accumulation in renal cells which significantly contributes to CKD [221]