Beneficial effects of weight loss in overweight patients with chronic proteinuric nephropathies

Morales, Enrique; Valero, M.A.; León, Miguel A Miranda de; Hernández, Eduardo; Praga, Manuel

doi:10.1053/ajkd.2003.50039

Cited by 280 publications

(164 citation statements)

References 23 publications

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“…Although high-protein consumption has been demonstrated to increase proteinuria in short-term human trials (18), our study did not find any differential effects between diets on urinary albumin excretion. Weight loss, which was similar between groups, can itself reduce proteinuria (41,42) and probably dwarfed any effects of the dietary components. Thus, there is no indication that a low-carbohydrate high-protein diet had deleterious effects on albuminuria.…”

Section: Discussionmentioning

confidence: 85%

Comparative Effects of Low-Carbohydrate High-Protein Versus Low-Fat Diets on the Kidney

Friedman

Ogden

Foster

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Concerns exist about deleterious renal effects of low-carbohydrate high-protein weight loss diets. This issue was addressed in a secondary analysis of a parallel randomized, controlled long-term trial.Design, setting, participants, and measurements Between 2003 and 2007, 307 obese adults without serious medical illnesses at three United States academic centers were randomly assigned to a low-carbohydrate highprotein or a low-fat weight-loss diet for 24 months. Main outcomes included renal filtration (GFR) indices (serum creatinine, cystatin C, creatinine clearance); 24-hour urinary volume; albumin; calcium excretion; and serum solutes at 3, 12, and 24 months.Results Compared with the low-fat diet, low-carbohydrate high-protein consumption was associated with minor reductions in serum creatinine (relative difference, 24.2%) and cystatin C (28.4%) at 3 months and relative increases in creatinine clearance at 3 (15.8 ml/min) and 12 (20.8 ml/min) months; serum urea at 3 (14.4%), 12 (9.0%), and 24 (8.2%) months; and 24-hour urinary volume at 12 (438 ml) and 24 (268 ml) months. Urinary calcium excretion increased at 3 (36.1%) and 12 (35.7%) months without changes in bone density or clinical presentations of new kidney stones.Conclusions In healthy obese individuals, a low-carbohydrate high-protein weight-loss diet over 2 years was not associated with noticeably harmful effects on GFR, albuminuria, or fluid and electrolyte balance compared with a low-fat diet. Further follow-up is needed to determine even longer-term effects on kidney function.

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Section: Discussionmentioning

confidence: 85%

Comparative Effects of Low-Carbohydrate High-Protein Versus Low-Fat Diets on the Kidney

Friedman

Ogden

Foster

et al. 2012

Clinical Journal of the American Society of Nephrology

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“…Several studies showed that obese patients could develop proteinuria and progressive loss of renal function, 17,18 and weight loss improved them. 8,19 The proposed mechanisms by which obesity increased renal risk include increasing GFR, 20 focal segmental glomerulosclerosis, 21 activation of the rennin-angiotensin system, 8 and adipocyte-derived cytokines. 22 However, the impact mechanism underlying the increased renal risk of obesity is not fully understood.…”

Section: Discussionmentioning

confidence: 99%

Effect of weight loss using formula diet on renal function in obese patients with diabetic nephropathy

et al. 2005

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OBJECTIVE:To evaluate the effect and safety of treatment with low-calorie formula diet on renal function and proteinuria in obese patients with diabetic nephropathy. DESIGN: Prospective study on safety and efficacy of a 4-week low-calorie (11-19 kcal/kg/day) normal-protein (0.9-1.2 g/kg/ day) diet partly supplemented with formula diet. SUBJECTS: In all, 22 obese patients with diabetic nephropathy (BMI: 30.475.3 kg/m 2 , HbA1c: 7.171.4%, serum creatinine: 172.4757.5 mmol/l, urinary protein: 3.372.6 g/day). RESULTS: The mean body weight decreased by 6.273.0 kg. The mean systolic blood pressure, creatinine, blood urea nitrogen, urinary protein, and 8-hydroxydeoxyguanosine decreased significantly by 7.5712.7 mmHg, 41.6723.9 mmol/l, 1.5071.61 mmol/l, 1.871.7 g/day, and 3.173.6 ng/mg creatinine, respectively. No patient had increased serum creatinine and urinary protein. Mean creatinine clearance (40.6717.9 to 46.1714.6 ml/s/1.73 m 2 ) and serum albumin showed no significant changes. Dserum creatinine and Durinary protein correlated with Dbody weight (r ¼ 0.62 and 0.49, respectively) and Dvisceral fat area (r ¼ 0.58 and 0.58, respectively), but did not correlate with Dsystolic blood pressure, Dfasting blood glucose and Dsubcutaneous fat area. CONCLUSION: These results suggested that weight reduction using formula diet might improve renal function and proteinuria safely for a short term in obese patients with diabetic nephropathy.

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“…In DCCT, abdominal obesity, evaluated by waist circumference, was associated with a higher incidence of albuminuria, but did not predict a decline in GFR [34]. On the other hand, weight loss reduces urinary albumin excretion and prevents the decline in GFR [40,41].…”

Section: Abbreviationsmentioning

confidence: 99%

Diabetic Nephropathy: New Risk Factors and Improvements in Diagnosis

2015

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■ AbstractDiabetic nephropathy is the leading cause of end-stage renal disease. Patients with diabetic nephropathy have a high cardiovascular risk, comparable to patients with coronary heart disease. Accordingly, identification and management of risk factors for diabetic nephropathy as well as timely diagnosis and prompt management of the condition are of paramount importance for effective treatment. A variety of risk factors promotes the development and progression of diabetic nephropathy, including elevated glucose levels, long duration of diabetes, high blood pressure, obesity, and dyslipidemia. Most of these risk factors are modifiable by antidiabetic, antihypertensive, or lipid-lowering treatment and lifestyle changes. Others such as genetic factors or advanced age cannot be modified. Therefore, the rigorous management of the modifiable risk factors is essential for preventing and delaying the decline in renal function. Early diagnosis of diabetic nephropathy is another essential component in the management of diabetes and its complications such as nephropathy. New markers may allow earlier diagnosis of this common and serious complication, but further studies are needed to clarify their additive predictive value, and to define their cost-benefit ratio. This article reviews the most important risk factors in the development and progression of diabetic nephropathy and summarizes recent developments in the diagnosis of this disease.

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Beneficial effects of weight loss in overweight patients with chronic proteinuric nephropathies

Cited by 280 publications

References 23 publications

Comparative Effects of Low-Carbohydrate High-Protein Versus Low-Fat Diets on the Kidney

Comparative Effects of Low-Carbohydrate High-Protein Versus Low-Fat Diets on the Kidney

Effect of weight loss using formula diet on renal function in obese patients with diabetic nephropathy

Diabetic Nephropathy: New Risk Factors and Improvements in Diagnosis

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