Weight loss: a neglected intervention in the management of chronic kidney disease.
OBJECTIVE
Obesity is being increasingly implicated as an independent risk factor for the development of chronic kidney disease (CKD), raising the question whether reversing obesity can be utilized as a mainstay or an adjunct therapy for CKD and possibly for its prevention. The purpose of this review is to examine the impact of treatment of obesity on renal outcomes.


RESULTS
Many observations have pointed to improvement in renal parameters following weight loss. In fact, both surgical and nonsurgical approaches appear to be effective at reducing blood pressure and proteinuria. Weight loss has also been shown to lower glomerular filtration rate (GFR) in obese patients, not an insignificant benefit considering that intra-glomerular hypertension and the subsequent hyperfiltration in the setting of obesity might be a main driver for the development of CKD.


CONCLUSIONS
Urinary protein excretion, blood pressure, and GFR improve with surgical and nonsurgical weight loss interventions. Whether improvements in these surrogate outcomes after weight loss actually translate into a reduction in the risk of CKD or amelioration in the rate of progression of established CKD is yet to be determined.
Ibrahim
Hassan N
HN
Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis, Minnesota 55414, USA. ibrah007@umn.edu
Weber
Marc L
ML
D001794:Blood Pressure; D002908:Chronic Disease; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D009765:Obesity / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D011507:Proteinuria / Q000209:etiology / Q000517:prevention & control; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D015431:Weight Loss