A structured weight management programme can achieve improved functional ability and significant weight loss in obese patients with chronic kidney disease
A structured weight management programme can achieve improved functional ability and significant weight loss in obese patients with chronic kidney disease
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DOI：
10.1093/ndt/gfm511
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发表时间：
2008-01-01
影响因子：
6.1
通讯作者：
Macdougall, Iain C.
中科院分区：
文献类型：
--
作者：
Cook, Sharlene A.;MacLaughlin, Helen;Macdougall, Iain C.
背景。肥胖患者[体重指数（BMI） bbb30 kg/m(2)]的肾移植预后较差，因此这些患者经常被排除在移植等待名单之外。基于高纤维、低能量饮食和运动的传统减肥策略通常不适合慢性肾脏疾病（CKD）人群。一项综合的多学科体重管理计划，包括低脂肪，低能量饮食，个人运动处方和奥利司他120mg tds的药物治疗，以确定肥胖CKD患者是否可以达到可接受的移植体重。32名完成12个月项目的患者定期接受体重、腰围测量和运动表现测试的监测。22例患者作为同期对照组。运动表现测试包括6分钟计时步行测试（6MTWT）， 60秒坐立转换（STS60），计时起身和走3米（TUAG）和Dukes活动状态指数（DASI），一种功能能力的测量。弗里德曼的测试分析评估基线和12个月数据之间的差异。平均体重下降7.1%，从102.9 kg降至95.7 kg （P < 0.001）。这相当于BMI从基线时的35.7 kg/m(2)降至12个月时的33.2 kg/m(2)。12个月时腰围由112.9 cm减至100.0 cm，减少12.9 cm （P < 0.005）。12个月后，6MTWT改善了45% (P < 0.001)， STS60改善了30% (P < 0.001)， TUAG改善了37% (P < 0.001)， DASI改善了50% （P < 0.001）。到目前为止，两名患者已经接受了活体肾移植，另外七名患者已经成功进入移植等待名单。这个多学科项目结合饮食、运动和奥利司他的初步经验表明，肥胖CKD患者可以实现显著的体重减轻和身体功能改善，这可能使他们有机会进行肾移植，与长期透析相比，肾移植带来的相关益处。
Background. Kidney transplantation in obese patients [body mass index (BMI) > 30 kg/m(2)] is associated with a poorer outcome, and these patients are therefore often excluded from transplant waiting lists. Conventional weight loss strategies based on a high fibre, low energy diet and exercise are often unsuitable in the chronic kidney disease (CKD) population. A comprehensive multidisciplinary weight management programme comprising a low fat, reduced energy diet, individual exercise prescription and pharmacotherapy with orlistat 120 mg tds, was initiated to determine whether obese patients with CKD could reach an acceptable weight for transplantation.Methods. Thirty-two patients who completed 12 months in the programme were monitored regularly for weight and waist circumference measures as well as exercise performance tests. Twenty-two patients formed a contemporaneous control group. Exercise performance tests included the 6 min timed walk test (6MTWT), sit to stand transfers in 60 s (STS60), timed up and go 3 m (TUAG) and the Dukes activity status index (DASI), a measure of functional ability.Results. Friedman's test analyses were performed to assess differences between baseline and 12-month data. Mean body weight reduced by 7.1% from 102.9 kg to 95.7 kg (P < 0.001) This equates to a reduction in BMI from 35.7 kg/m(2) at baseline to 33.2 kg/m(2) at 12 months. Waist circumference decreased by 12.9 cm from 112.9 cm to 100.0 cm (P < 0.005) at 12 months. The 6MTWT improved by 45% (P < 0.001), STS60 by 30% (P < 0.001), TUAG by 37% (P < 0.001) and DASI by 50% (P < 0.001) after 12 months. To date, two of the patients have received live-related renal transplants and an additional seven patients have now been successfully enrolled onto the transplant waiting list.Conclusion. Preliminary experience from this multidisciplinary programme combining diet, exercise and orlistat suggests that significant weight loss and improved physical functioning can be achieved in obese CKD patients, potentially allowing them the opportunity of kidney transplantation and the associated benefits of this compared with long-term dialysis.