Effects of weight reduction regimens and bariatric surgery on chronic kidney disease in obese patients

Abstract

Increasing evidence nowadays is showing that obesity by itself, independent of other comorbidities like diabetes and hypertension, is associated with renal functional changes and structural damage. Intentional weight loss demonstrates beneficial reduction in proteinuria and albuminuria in patients with mild to moderate chronic kidney disease, particularly those whose renal damage is likely induced by obesity. The safety of some weight loss interventions, particularly the use of high-protein diets and/or medications, is questionable in this population due to the lack of well-designed randomized controlled studies reporting on their efficacy or harm. Bariatric surgery showed the most promising results with regards to ameliorating glomerular hyperfiltration and albuminuria albeit with a modest risk of increased perioperative complications with advanced stages of chronic kidney disease (CKD).

Long-Term Effects of a Very Low Carbohydrate Compared With a High Carbohydrate Diet on Renal Function in Individuals With Type 2 Diabetes

“… 13 , 14 This suggests that weight loss-induced increases in eGFR may more likely occur in populations with preexisting renal dysfunction, a phenomenon that has also been observed postbariatric surgery. 24 Moreover, the overall reduction in albuminuria over time and the normalization of levels in patients with albuminuria at baseline support the benefits of weight loss. 25 …”

Weight management strategies for those with chronic kidney disease: A consensus report from the Asia Pacific Society of Nephrology and Australia and New Zealand Society of Nephrology 2016 renal dietitians meeting

“…CINAHL, ProQuest, PubMed, Medline and Embase databases were searched for appropriate articles and initially provided 30 studies. Three randomized ( n = 58 subjects) and 12 non‐randomized trials ( n = 882 subjects) as well as one narrative review and one systematic review were included for review. The combined sample size in the systematic review was 2013 subjects ( n = 574 receiving medication only; n = 562 undertaking bariatric surgery; n = 877 included in diet and lifestyle interventions .…”

Estimated GFR Before and After Bariatric Surgery in CKD

“…Several reviews have recently been published 10–15 detailing the beneficial effects that weight loss surgery has on kidney function. However, there are a number of limitations in the literature to date.…”