title: Weight loss interventions in chronic kidney disease: a systematic review and meta-analysis.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.affiliation: Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA. navanes@ccf.org
authors.forename: Sankar D
authors.initials: SD
authors.lastname: Navaneethan
authors.forename: Hans
authors.initials: H
authors.lastname: Yehnert
authors.forename: Fady
authors.initials: F
authors.lastname: Moustarah
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Schreiber
authors.forename: Philip R
authors.initials: PR
authors.lastname: Schauer
authors.forename: Srinivasan
authors.initials: S
authors.lastname: Beddhu
mesh_terms: D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000503:physiopathology*; D009765:Obesity / Q000150:complications; D011507:Proteinuria / Q000517:prevention & control; D013599:Systole; D015431:Weight Loss
chemical_list: D001786:Blood Glucose; D003404:Creatinine