Beneficial effects of weight loss in overweight patients with chronic proteinuric nephropathies
Beneficial effects of weight loss in overweight patients with chronic proteinuric nephropathies
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DOI：
10.1053/ajkd.2003.50039
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发表时间：
2003-02-01
影响因子：
13.2
通讯作者：
Praga, M
中科院分区：
文献类型：
--
作者：
Morales, E;Valero, MA;Praga, M
背景蛋白尿是公认的肥胖并发症，但没有研究探讨体重减轻对不同原因的慢性蛋白尿性肾病超重患者的影响。研究方法：我们将30名超重的糖尿病和非糖尿病蛋白尿性肾病患者（体重指数[BMI] > 27 kg/m2）随机分配（以2：1的比例），要么遵循低热量正常蛋白饮食，要么保持他们通常的饮食摄入5个月。主要结果是尿蛋白排泄的变化。次要结局是肾功能（血清肌酐水平和Cockcroft-Gault肌酐清除率）和血脂的变化。结果如下：饮食组患者的体重和BMI显著降低，而对照组患者的体重和BMI显著增加（组间比较，P < 0.05）。饮食组的平均体重减轻为4.1% ± 3%，该组20名患者中有14名体重减轻超过3%。饮食组的蛋白尿减少了31.2% +/- 37%（从2.8 +/- 1.4 g/24 h降至1.9 +/- 1.4 g/24 h; P < 0.005），而对照组的蛋白尿有增加的趋势（组间比较，P < 0.05）。两组间肾功能变化无显著差异，但饮食组肾功能保持稳定，对照组肾功能显著恶化。饮食组血清甘油三酯水平保持稳定，对照组有升高趋势（组间比较，P < 0.05）。结论：慢性蛋白尿肾病超重患者适度减肥可显著降低蛋白尿。
Background Proteinuria is a recognized complication of obesity, but no study has investigated the effect of weight loss in overweight patients with chronic proteinuric nephropathies of different causes. Methods: We randomly assigned (in a 2:1 ratio) 30 overweight patients (body mass index [BMI] > 27 kg/m(2)) with diabetic and nondiabetic proteinuric nephropathies to either follow a low-calorie normoproteinic diet or maintain their usual dietary intake for 5 months. The primary outcome was change in urinary protein excretion. Secondary outcomes were changes in renal function (serum creatinine level and Cockcroft-Gault creatinine clearance) and lipid profile. Results: Patients in the diet group showed a significant decrease in body weight and BMI, whereas patients in the control group showed a significant increase in body weight and BMI (between-group comparison, P < 0.05). Mean weight loss in the diet group was 4.1% +/- 3%, and 14 of 20 patients in this group lost more than 3%. Proteinuria decreased by 31.2% +/- 37% in the diet group (from protein of 2.8 +/- 1.4 to 1.9 +/- 1.4 g/24 h; P < 0.005), whereas it tended to increase in the control group (between-group comparison, P < 0.05). Changes in renal function did not differ significantly between groups, although renal function remained stable in the diet group and showed significant worsening in the control group. Serum triglyceride levels remained stable in the diet group and tended to increase in the control group (between-group comparison, P < 0.05). Conclusion: Moderate weight loss in overweight patients with chronic proteinuric nephropathies induces a significant decrease in proteinuria.