Weight Loss Interventions in Chronic Kidney Disease: A Systematic Review and Meta-analysis
Weight Loss Interventions in Chronic Kidney Disease: A Systematic Review and Meta-analysis
复制标题
DOI：
10.2215/cjn.02250409
复制
发表时间：
2009-10-01
影响因子：
9.8
通讯作者：
Beddhu, Srinivasan
中科院分区：
文献类型：
--
作者：
Navaneethan, Sankar D.;Yehnert, Hans;Beddhu, Srinivasan
背景和目的：肥胖是慢性肾脏病（CKD）发生和进展的独立危险因素。我们进行了一项系统性综述，以评估有意减肥对非透析依赖性慢性肾脏病和肾小球超滤患者的益处。设计、设置、参与者和测量：我们搜索了MEDLINE、SCOPUS和会议记录，以寻找随机对照试验和观察性研究，这些研究检查了成人慢性肾脏病患者的各种手术和非手术干预措施（饮食、运动和/或减肥药）。结果：共纳入13篇文献。在CKD患者中，在研究结束时，非手术干预的体重指数（BMI）显著降低（加权平均差异[WMD] -3.67 kg/m2; 95%置信区间[CI] -6.56至-0.78）。这与蛋白尿（WMD-1. 31 g/24 h; 95% CI-2. 11至-0. 51）和收缩压显著降低相关，平均随访7. 4个月期间GFR未进一步降低。在病态肥胖的个体中（BMI >40 kg/m2）伴肾小球高滤过（GFR >125 ml/min），手术干预降低BMI，导致GFR降低（WMD为-25.56 ml/min; 95% CI为-36.23至-14.89）、蛋白尿和收缩压。在CKD患者的小型短期研究中，非手术减肥干预可减少蛋白尿和血压，似乎可防止肾功能进一步下降。在伴有肾小球高滤过的病态肥胖患者中，手术干预可使GFR正常化，降低血压和微量白蛋白尿。需要更大规模的长期研究来分析肾脏结局，如ESRD的发展。Clin J Am Soc Neplirol 4：1565-1574，2009. doi：10.2215/CJN.02250409
Background and objectives: Obesity is an independent risk factor for development and progression of chronic kidney disease (CKD). We conducted a systematic review to assess the benefits of intentional weight loss in patients with non-dialysis-dependent CKD and glomerular hyperfiltration.Design, setting, participants, & measurements: We searched MEDLINE, SCOPUS, and conference proceedings for randomized, controlled trials and observational studies that examined various surgical and nonsurgical interventions (diet, exercise, and/or antiobesity agents) in adult patients with CKD. Results were summarized using random-effects model.Results: Thirteen studies were included. In patients with CKD, body mass index (BMI) decreased significantly (weighted mean difference [WMD] -3.67 kg/m(2); 95% confidence interval [CI] -6.56 to -0.78) at the end of the study period with nonsurgical interventions. This was associated with a significant decrease in proteinuria (WMD -1.31 g/24 h; 95% CI -2.11 to -0.51) and systolic BP with no further decrease in GFR during a mean follow-up of 7.4 mo. In morbidly obese individuals (BMI >40 kg/m(2)) with glomerular hyperfiltration (GFR >125 ml/min), surgical interventions decreased BMI, which resulted in a decrease in GFR (WMD -25.56 ml/min; 95% CI -36.23 to -14.89), albuminuria, and systolic BP.Conclusions: In smaller, short-duration studies in patients with CKD, nonsurgical weight loss interventions reduce proteinuria and BP and seem to prevent further decline in renal function. In morbidly obese individuals with glomerular hyperfiltration, surgical interventions normalize GFR and reduce BP and microalbuminuria. Larger, long-term studies to analyze renal outcomes such as development of ESRD are needed. Clin J Am Soc Neplirol 4: 1565-1574, 2009. doi: 10.2215/CJN.02250409