Strategies to Treat Obesity in Patients With CKD.
Strategies to Treat Obesity in Patients With CKD.
复制标题
治疗CKD患者肥胖的策略。
DOI：
10.1053/j.ajkd.2020.08.016
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发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
Chang AR
中科院分区：
文献类型：
--
作者：
Chintam K;Chang AR
肥胖症在全球范围内持续增加，伴随着高血压、糖尿病和慢性肾病（CKD）的上升趋势。虽然体重指数通常用于评估临床实践中的肥胖，但CKD患者的身体组成改变（例如肌肉质量减少，内脏肥胖增加）很常见。通过行为改变或药物治疗实现的体重减轻减少了蛋白尿，在某些情况下，减缓了估计肾小球滤过率（eGFR）的下降。应促进使用具有良好心血管风险特征的促进体重减轻的药物，特别是2型糖尿病，肥胖和CKD患者。对于那些未能通过改变生活方式实现减肥的人，应考虑减肥手术，因为观察性研究表明eGFR下降和肾衰竭的风险降低。由于缺乏前瞻性试验和观察数据的局限性，肾衰竭患者故意减肥的风险-受益比仍然不确定。无论如何，袖状胃切除术越来越多地用于肾衰竭和严重肥胖患者，成功地实现了持续的体重减轻，改善了肾移植的可及性，以及良好的移植后结局。需要更多的研究来评估大多数减肥药物的长期心血管和肾脏结果。
Obesity prevalence continues to increase worldwide, accompanied by a rising tide of hypertension, diabetes, and chronic kidney disease (CKD). While body mass index is typically used to assess obesity in clinical practice, altered body composition (e.g. reduced muscle mass, increased visceral adiposity) are common among patients with CKD. Weight loss achieved through behavioral modification or medications reduces albuminuria, and in some cases, slows decline in estimated glomerular filtration rate (eGFR). Use of medications that promote weight loss with favorable cardiovascular risk profiles should be promoted, particularly in patients with type 2 diabetes, obesity, and CKD. For those who fail to achieve weight loss through lifestyle modification, bariatric surgery should be considered, as observational studies have shown reductions in risk of eGFR decline and kidney failure. Uncertainty persists on the risk-benefit ratio of intentional weight loss in patients with kidney failure, due to lack of prospective trials and limitations of observational data. Regardless, sleeve gastrectomy is increasingly being used for patients with kidney failure and severe obesity with success in achieving sustained weight loss, improved access to kidney transplantation, and favorable post-transplant outcomes. More research is needed assessing long-term cardiovascular and kidney outcomes of most weight loss medications.
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