Effect of an Intensive Weight-Loss Lifestyle Intervention on Kidney Function: A Randomized Controlled Trial

Abstract

<b><i>Introduction:</i></b> Large randomized trials testing the effect of a multifactorial weight-loss lifestyle intervention including Mediterranean diet (MedDiet) on renal function are lacking. Here, we evaluated the 1-year efficacy of an intensive weight-loss intervention with an energy-reduced MedDiet (erMedDiet) plus increased physical activity (PA) on renal function. <b><i>Methods:</i></b> Randomized controlled “PREvención con DIeta MEDiterránea-Plus” (PREDIMED-Plus) trial is conducted in 23 Spanish centers comprising 208 primary care clinics. Overweight/obese (<i>n</i> = 6,719) adults aged 55–75 years with metabolic syndrome were randomly assigned (1:1) to an intensive weight-loss lifestyle intervention with an erMedDiet, PA promotion, and behavioral support (intervention) or usual-care advice to adhere to an energy-unrestricted MedDiet (control) between September 2013 and December 2016. The primary outcome was 1-year change in estimated glomerular filtration rate (eGFR). Secondary outcomes were changes in urine albumin-to-creatinine ratio (UACR), incidence of moderately/severely impaired eGFR (<60 mL/min/1.73 m<sup>2</sup>) and micro- to macroalbuminuria (UACR ≥30 mg/g), and reversion of moderately (45 to <60 mL/min/1.73 m<sup>2</sup>) to mildly impaired GFR (60 to <90 mL/min/1.73 m<sup>2</sup>) or micro- to macroalbuminuria. <b><i>Results:</i></b> After 1 year, eGFR declined by 0.66 and 1.25 mL/min/1.73 m<sup>2</sup> in the intervention and control groups, respectively (mean difference, 0.58 mL/min/1.73 m<sup>2</sup>; 95% CI: 0.15–1.02). There were no between-group differences in mean UACR or micro- to macroalbuminuria changes. Moderately/severely impaired eGFR incidence and reversion of moderately to mildly impaired GFR were 40% lower (HR 0.60; 0.44–0.82) and 92% higher (HR 1.92; 1.35–2.73), respectively, in the intervention group. <b><i>Conclusions:</i></b> The PREDIMED-Plus lifestyle intervention approach may preserve renal function and delay CKD progression in overweight/obese adults.

A Specific High-Protein Weight Loss Program Does Not Impair Renal Function in Patients Who Are Overweight/Obese

“…Indeed, other injury pathways have been implicated, notably a role of increased inflammation with adipokine dysregulation, neurohumoral activation, and increased sodium reabsorption [31]. Similar to our study, a recent RCT trial assessing the effect of a weight-loss lifestyle intervention based on an energy-restricted Mediterranean diet showed favorable one-year outcomes by reducing eGFR decline [32]. However, the mean achieved weight loss was only 3.7 kg, which seems lower than the 8% objective of weight reduction of the study and much lower than the magnitude of weight reduction obtained in our study.…”

“…The best option to estimate GFR in patients who are obese remains an unsolved issue, with specific questions, such as the indexation to body surface area, and even cystatine-C appears to be influenced by body fat [41]. Hence, as an example, in the study by Diaz-Lopez et al [32], the mean eGFR difference between both groups was very low; meanwhile, no difference in mean urine albumin-to-creatinine ratio was noted, which could testify that the mean eGFR difference did not represent a significant clinical effect of the intervention. Thus far, there is no validated equation for the estimation of the renal function of patients who are obese, and the MDRD equation can be biased in this population [42].…”

Long-term consumption of a mediterranean diet or a low-fat diet on kidney function in coronary heart disease patients: The CORDIOPREV randomized controlled trial

“…In a recent weight-loss intervention-based study, PREDIMED-Plus, the 1-year consumption of an energy-reduced Mediterranean diet and increased physical activity (intervention group) led to a lower decline in eGFR, in comparison with the control group, who were given the usual advice recommending a Mediterranean diet, in overweight/obese adults with metabolic syndrome [13]. In this study, the eGFR decline rate was z0.6 mL/min/1.73 m 2 lower in the intervention group than in the control group, which could be partly attributed, according to the authors, to weight loss in the patients following this diet.…”

Longitudinal Change in The Cumulative Incidence and Maintenance Rate of Metabolic Syndrome among Participants of the Specifific Health Check and Guidance System in Japan

“…Recently, we confirmed that MetS was a significant risk Health Educ Public Health 2022, 5:2 factor for mortality [18]. Therefore, early intervention in overweight/obese adults, namely MetS subjects is necessary to prevent the progression of CKD [24,25] and death.…”