Short-Term Changes after a Weight Reduction Intervention in Advanced Diabetic Nephropathy

Friedman, Allon N.; Chambers, Mary; Kamendulis, Lisa M.; Temmerman, Joan

doi:10.2215/cjn.04010413

Cited by 66 publications

(70 citation statements)

References 45 publications

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“…It is crucial for nephrologists to learn how to assess fat mass distribution, identify metabolically benign obesity in the uremic milieu, and manage and treat obese CKD patients. Moreover, as a recent study demonstrates an important role for mitochondrial dynamics in the central regulation of energy metabolism, 118 further studies should address mitochondrial function in obesity and CKD. The treatment of obesity requires a multifaceted approach, including but not limited to weight reduction and physical exercise programs.…”

Section: Discussionmentioning

confidence: 99%

Obesity in CKD—What Should Nephrologists Know?

Stenvinkel

Zoccali

İkizler

2013

Journal of the American Society of Nephrology

200

172

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Obesity, the epidemic of the 21st century, carries a markedly increased risk for comorbid complications, such as type 2 diabetes, cancer, hypertension, dyslipidemia, cardiovascular disease, and sleep apnea. In addition, obesity increases the risk for CKD and its progression to ESRD. Paradoxically, even morbid obesity associates with better outcomes in studies of ESRD patients on maintenance dialysis. Because the number of obese CKD and maintenance dialysis patients is projected to increase markedly in developed as well as low-and middle-income countries, obesity is a rapidly emerging problem for the international renal community. Targeting the obesity epidemic represents an unprecedented opportunity for health officials to ameliorate the current worldwide increase in CKD prevalence. Nephrologists need more information about assessing and managing obesity in the setting of CKD. Specifically, more precise estimation of regional fat distribution and the amount of muscle mass should be introduced into regular clinical practice to complement more commonly used practical markers, such as body mass index. Studies examining the effects of obesity on kidney disease progression and other clinical outcomes along with weight management strategies are much needed in this orphan area of research. 24: 172724: -173624: , 201324: . doi: 10.1681 Obesity has emerged as the largest pandemic in near history, with important implications of not only cardiovascular disease (CVD) but also CKD. Recent data from the United States indicate that the incidence and prevalence rates of obesity in maintenance dialysis patients largely exceed the corresponding figures in the general population. 1 A large European population survey documented that a high body mass index (BMI) ranks as one of the strongest risk factors for new-onset CKD. 2 The dimension of the obesity epidemic and the impact of the same epidemic on the kidney demand efforts for understanding the epidemiology and the mechanisms of CKD associated with excess adiposity. It also sets as an absolute public health priority for the development of treatment policies integrated across specialties and general practice to halt this much concerning problem. In this scenario, it is fundamental that nephrologists are updated on current knowledge about obesity in the setting of CKD. However, little attention is still paid to this issue in major nephrology journals. The suboptimal attention to the problem by major sources of dissemination of specialty information suggests that nephrologists may have scarce knowledge of how obesity should be assessed, its epidemiology, mechanisms whereby excess fat mass is conducive to CKD, and management of obesity in the catabolic uremic milieu. 3 J Am Soc Nephrol DEFINITION AND ASSESSMENT OF OBESITYThe most common method for defining obesity is based on BMI (i.e., a person's weight as obese. It should be emphasized that population norms of BMI could be different based on ethnic and racial background (i.e., the proportion of Asian people with a high ...

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Section: Discussionmentioning

confidence: 99%

Obesity in CKD—What Should Nephrologists Know?

Stenvinkel

Zoccali

İkizler

2013

Journal of the American Society of Nephrology

200

172

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“…Friedman and colleagues [51] looked at the short-term impact of weight-reducing interventions in patients with advanced DKD. Six participants with advanced DKD (eGFR <40 mL/min/1.73 m 2 , urinary albumin excretion >30 mg/ 24 h) underwent a 12-week very low-calorie ketogenic weight reduction diet and were encouraged to exercise over 6 months.…”

Section: Lifestyle-prospective Observationalmentioning

confidence: 99%

Weight Loss Interventions and Progression of Diabetic Kidney Disease

2015

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Progressive renal impairment (diabetic kidney disease (DKD)) occurs in upwards of 40 % of patients with obesity and type 2 diabetes mellitus (T2DM) and is a cause of significant morbidity and mortality. Means of attenuating the progression of DKD focus on amelioration of risk factors. Visceral obesity is implicated as a causative agent in impaired metabolic and cardiovascular control in T2DM, and various approaches primarily targeting weight have been examined for their impact on markers of renal injury and dysfunction in DKD. The current report summarises the evidence base for the impact of surgical, lifestyle and pharmacological approaches to weight loss on renal end points in DKD. The potential for a threshold of weight loss more readily achievable by surgical intervention to be a prerequisite for renal improvement is highlighted. Comparing efficacious non-surgical weight loss strategies with surgical strategies in appropriately powered and controlled prospective studies is a priority for the field.

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“…There was no report of use of potassium binding resins but adjustment to potassium dialysate concentration was reported for one patient. Similarly, Friedman et al were able to achieve an average weight loss of 14.2 kg in five patients with advanced diabetes nephropathy with the use of VLCD for a period of 12 weeks. They observed a statistically significant approximate reduction of 12% in serum creatinine and cystatin C and a 36% non‐statistically significant reductions in albuminuria and a nonsignificant increase in albumin.…”

Section: How Effective Are Vlcds In Those With Ckd or Eskd?mentioning

confidence: 86%

A practical guide for the use of very low calorie diets in adults with chronic kidney disease

et al. 2019

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Obesity is increasingly common in individuals with chronic kidney disease (CKD). Being overweight or obese is associated with both the development and progression of kidney disease. Lifestyle interventions such as the use of very low‐calorie diets (VLCD) are being used increasingly for patients with CKD despite warnings from manufacturers that they should be avoided or used with caution. Whilst these diets are effective and can induce rapid weight loss and suppress appetite, their use in patients with chronic and end stage kidney disease is more complex than in the general population. VLCD use in adults with kidney disease requires a more nuanced approach to prescription and closer monitoring for unintended side effects. This review describes the indications and clinical management of patients with CKD undertaking a very low‐calorie diet and provides practical guidance regarding how to manage a VLCD, particularly for the latter stages of CKD.

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Short-Term Changes after a Weight Reduction Intervention in Advanced Diabetic Nephropathy

Cited by 66 publications

References 45 publications

Obesity in CKD—What Should Nephrologists Know?

Obesity in CKD—What Should Nephrologists Know?

Weight Loss Interventions and Progression of Diabetic Kidney Disease

A practical guide for the use of very low calorie diets in adults with chronic kidney disease

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