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Weight loss interventions in chronic kidney disease: a systematic review and meta-analysis.
Clin J Am Soc Nephrol 2009; 4(10):1565-74CJ

Abstract

BACKGROUND AND OBJECTIVES

Obesity is an independent risk factor for development and progression of chronic kidney disease (CKD). We conducted a systematic review to assess the benefits of intentional weight loss in patients with non-dialysis-dependent CKD and glomerular hyperfiltration.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

We searched MEDLINE, SCOPUS, and conference proceedings for randomized, controlled trials and observational studies that examined various surgical and nonsurgical interventions (diet, exercise, and/or antiobesity agents) in adult patients with CKD. Results were summarized using random-effects model.

RESULTS

Thirteen studies were included. In patients with CKD, body mass index (BMI) decreased significantly (weighted mean difference [WMD] -3.67 kg/m(2); 95% confidence interval [CI] -6.56 to -0.78) at the end of the study period with nonsurgical interventions. This was associated with a significant decrease in proteinuria (WMD -1.31 g/24 h; 95% CI -2.11 to -0.51) and systolic BP with no further decrease in GFR during a mean follow-up of 7.4 mo. In morbidly obese individuals (BMI >40 kg/m(2)) with glomerular hyperfiltration (GFR >125 ml/min), surgical interventions decreased BMI, which resulted in a decrease in GFR (WMD -25.56 ml/min; 95% CI -36.23 to -14.89), albuminuria, and systolic BP.

CONCLUSIONS

In smaller, short-duration studies in patients with CKD, nonsurgical weight loss interventions reduce proteinuria and BP and seem to prevent further decline in renal function. In morbidly obese individuals with glomerular hyperfiltration, surgical interventions normalize GFR and reduce BP and microalbuminuria. Larger, long-term studies to analyze renal outcomes such as development of ESRD are needed.

Authors+Show Affiliations

Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA. navanes@ccf.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

19808241

Citation

Navaneethan, Sankar D., et al. "Weight Loss Interventions in Chronic Kidney Disease: a Systematic Review and Meta-analysis." Clinical Journal of the American Society of Nephrology : CJASN, vol. 4, no. 10, 2009, pp. 1565-74.
Navaneethan SD, Yehnert H, Moustarah F, et al. Weight loss interventions in chronic kidney disease: a systematic review and meta-analysis. Clin J Am Soc Nephrol. 2009;4(10):1565-74.
Navaneethan, S. D., Yehnert, H., Moustarah, F., Schreiber, M. J., Schauer, P. R., & Beddhu, S. (2009). Weight loss interventions in chronic kidney disease: a systematic review and meta-analysis. Clinical Journal of the American Society of Nephrology : CJASN, 4(10), pp. 1565-74. doi:10.2215/CJN.02250409.
Navaneethan SD, et al. Weight Loss Interventions in Chronic Kidney Disease: a Systematic Review and Meta-analysis. Clin J Am Soc Nephrol. 2009;4(10):1565-74. PubMed PMID: 19808241.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Weight loss interventions in chronic kidney disease: a systematic review and meta-analysis. AU - Navaneethan,Sankar D, AU - Yehnert,Hans, AU - Moustarah,Fady, AU - Schreiber,Martin J, AU - Schauer,Philip R, AU - Beddhu,Srinivasan, Y1 - 2009/09/17/ PY - 2009/10/8/entrez PY - 2009/10/8/pubmed PY - 2010/1/8/medline SP - 1565 EP - 74 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 4 IS - 10 N2 - BACKGROUND AND OBJECTIVES: Obesity is an independent risk factor for development and progression of chronic kidney disease (CKD). We conducted a systematic review to assess the benefits of intentional weight loss in patients with non-dialysis-dependent CKD and glomerular hyperfiltration. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We searched MEDLINE, SCOPUS, and conference proceedings for randomized, controlled trials and observational studies that examined various surgical and nonsurgical interventions (diet, exercise, and/or antiobesity agents) in adult patients with CKD. Results were summarized using random-effects model. RESULTS: Thirteen studies were included. In patients with CKD, body mass index (BMI) decreased significantly (weighted mean difference [WMD] -3.67 kg/m(2); 95% confidence interval [CI] -6.56 to -0.78) at the end of the study period with nonsurgical interventions. This was associated with a significant decrease in proteinuria (WMD -1.31 g/24 h; 95% CI -2.11 to -0.51) and systolic BP with no further decrease in GFR during a mean follow-up of 7.4 mo. In morbidly obese individuals (BMI >40 kg/m(2)) with glomerular hyperfiltration (GFR >125 ml/min), surgical interventions decreased BMI, which resulted in a decrease in GFR (WMD -25.56 ml/min; 95% CI -36.23 to -14.89), albuminuria, and systolic BP. CONCLUSIONS: In smaller, short-duration studies in patients with CKD, nonsurgical weight loss interventions reduce proteinuria and BP and seem to prevent further decline in renal function. In morbidly obese individuals with glomerular hyperfiltration, surgical interventions normalize GFR and reduce BP and microalbuminuria. Larger, long-term studies to analyze renal outcomes such as development of ESRD are needed. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/19808241/full_citation L2 - http://cjasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=19808241 DB - PRIME DP - Unbound Medicine ER -