Management of Obesity-Induced Kidney Disease: A Critical Review of the Literature

Abstract

It is well established that obesity is a risk factor for the development of chronic kidney disease (CKD) and may promote the progression to end stage renal disease (ESRD). Therefore, it is strongly suggested that reduction of body weight can be an important intervention in order to reduce the prevalence of renal impairment. The current article describes extensively the already published trials which have studied the association between weight loss and kidney disease. The weight management programs include surgical and non-surgical interventions (low-calorie diet, aerobic exercise, drug-induced weight loss, combination treatment). The focus has been placed on the following renal function markers: albuminuria, proteinuria, glomerular filtration rate (GFR), and creatinine clearance. This review also aims to clarify challenges that clinicians have to deal with in everyday practice regarding the management of obesity-induced kidney disease (degree of weight loss, duration of the weight loss program, early initiation of the intervention).

The role of adiponectin in renal physiology and development of albuminuria

“…Thus, the fenofibrate-induced elevation of serum adiponectin levels may contribute to the concomitant decrease in UAE, because of the renoprotective effects of adiponectin. Consistently, unpublished data from a previous trial performed by our study group showed that the percentage change in circulating HMW adiponectin over 3 months of fenofibrate treatment was negatively correlated with the percentage change in urinary albumin to creatinine ratio (ACR) (rZK0.648, PZ0.043) (Christou et al 2012).…”

“…Obesity per se can induce renal injury resulting in albuminuria, independently of the presence of diabetes and hypertension which are often associated with obesity (Kiortsis & Christou 2012). Specifically, the renal effects of obesity can be divided into structural and functional effects.…”

“…It is well-known that albuminuria is associated with diabetes and obesity and that increasing albuminuria constitutes an adverse cardiovascular risk factor in these states (Gerstein et al 2000, Kiortsis & Christou 2012. Taking into account that adiponectin has been found to play an important role in the pathophysiology of diabetes, obesity and CVD, the elucidation of the relationship between the patterns of circulating adiponectin and UAE and of the pathophysiological interplay between adiponectin and albuminuria would help to clarify the exact role of adiponectin in the development of albuminuria that is associated with diabetes, obesity and CVD.…”

Obesity in CKD—What Should Nephrologists Know?

“…73 However, only a few studies have studied the effects of a healthy lifestyle on kidney function. 74 Small studies suggested improvements in estimated GFR and/or albuminuria with low-calorie diets, especially when weight loss has been significant. Although even small amounts of regular physical activity (150 min/wk) reduce all-cause and particularly, cardiovascular mortality, 75 the effects of physical activity on kidney function have not been studied in obese CKD patients.…”

“…Another study reports a significant improvement in renal parameters after bariatric surgery. 74 Alexander et al 82 reported that, in a series of 45 CKD patients who had undergone gastric bypass, nine patients had resolution, improvement, or stabilization of their kidney function. A study of 233 severely obese patients before and 12 months after bariatric surgery showed that mean estimated GFR increased in obese CKD patients.…”