REVIEW PAPER
Chronic kidney disease and obesity - pathomechanisms and treatment – literature review
1
Student Scientific Group of Internal Medicine, Clinical Department of Nephrology, Transplantology and Internal Medicine, Medical University, Lublin, Poland
2
Clinical Department of Nephrology, Transplantology and Internal Medicine, Medical University, Lublin, Poland
Corresponding author
Natalia Pijas
Student Scientific Group of Internal Medicine, Clinical Department of Nephrology, Transplantology and Internal Medicine, Medical University, Doktora Kazimierza Jaczewskiego 8, 20–954 Lublin, Poland
Student Scientific Group of Internal Medicine, Clinical Department of Nephrology, Transplantology and Internal Medicine, Medical University, Doktora Kazimierza Jaczewskiego 8, 20–954 Lublin, Poland
J Pre Clin Clin Res. 2024;18(3):218-223
KEYWORDS
TOPICS
ABSTRACT
Introduction and objective:
Chronic kidney disease (CKD) is a major health issue worldwide affecting 10–14% of the globe’s population, with a climbing trend. CKD is associated with a variety of factors, including obesity, which has grown increasingly prevalent and adds to the pathogenesis of the disease. The aim of the review is to summarise pathomechanism and current treatment methods of chronic kidney disease. Additionally, using this knowledge, treatment suggestions are provided for different patient groups.
Review methods:
A literature search was conducted in the PubMed database with inclusion criteria ‘English language’ and ‘free full texts’, and publications date between 2018 – 2023. A total of 1,172 results were found; 28 publications were ultimately included in the review.
Brief description of the state of knowledge:
The pathomechanisms include haemodynamic changes, oxidative stress, adipokine dysregulation, and correlations to insulin resistance and diabetes. Weight loss by proper nutrition and exercise is a,beneficial approach to manage CKD in obese patients. Bariatric surgery has proven a realistic alternative due to improvements in kidney function and obesity-related comorbidities. There are several options for pharmacotherapy in CKD and obesity, including SGLT2 inhibitors, GLP-1 analogues, agents targeting the renin-angiotensin-aldosterone system and bardoxolone methyl. Addressing obesity plays an essential role in alleviating CKD risk and progression.
Conclusions:
Early intervention involving lifestyle changes, weight reduction strategies, surgical procedures, and medication provides a holistic approach to addressing CKD in obese people. Recognizing the complex interplay of variables that contribute to CKD enables targeted therapy approaches and better patient outcomes.
Chronic kidney disease (CKD) is a major health issue worldwide affecting 10–14% of the globe’s population, with a climbing trend. CKD is associated with a variety of factors, including obesity, which has grown increasingly prevalent and adds to the pathogenesis of the disease. The aim of the review is to summarise pathomechanism and current treatment methods of chronic kidney disease. Additionally, using this knowledge, treatment suggestions are provided for different patient groups.
Review methods:
A literature search was conducted in the PubMed database with inclusion criteria ‘English language’ and ‘free full texts’, and publications date between 2018 – 2023. A total of 1,172 results were found; 28 publications were ultimately included in the review.
Brief description of the state of knowledge:
The pathomechanisms include haemodynamic changes, oxidative stress, adipokine dysregulation, and correlations to insulin resistance and diabetes. Weight loss by proper nutrition and exercise is a,beneficial approach to manage CKD in obese patients. Bariatric surgery has proven a realistic alternative due to improvements in kidney function and obesity-related comorbidities. There are several options for pharmacotherapy in CKD and obesity, including SGLT2 inhibitors, GLP-1 analogues, agents targeting the renin-angiotensin-aldosterone system and bardoxolone methyl. Addressing obesity plays an essential role in alleviating CKD risk and progression.
Conclusions:
Early intervention involving lifestyle changes, weight reduction strategies, surgical procedures, and medication provides a holistic approach to addressing CKD in obese people. Recognizing the complex interplay of variables that contribute to CKD enables targeted therapy approaches and better patient outcomes.
Pijas N, Domańska A, Pieniążek B, Piekarz D, Szeliga-Król J, Załuska W. Chronic kidney disease and obesity – pathomechanisms and treatment – literature review. J Pre-Clin Clin Res. 2024; 18(3): 218–223. doi:10.26444/jpccr/190537
REFERENCES (28)
1.
R Lo, Y Narasaki, S Lei, C M Rhee, Management of traditional risk factors for the development and progression of chronic kidney disease. Clin Kidney J. 2023;vol. 16, no. 11. doi: 10.1093/CKJ/SFAD101.
2.
Iqbal J, Wu HX, Nawaz MA, Jiang HL, Xu SN, Huang BL, Li L, Cai JM, Zhou HD. Risk of incident chronic kidney disease in metabolically healthy obesity and metabolically unhealthy normal weight: A systematic review and meta-analysis. Obes Rev. 2024;25(2):e13656. doi: 10.1111/obr.13656.
3.
Kovesdy CP. Epidemiology of chronic kidney disease: an update 2022. Kidney Int Suppl. 2022;12(1):7–11. doi: 10.1016/j.kisu.2021.11.003.
4.
Ibrahim M, Khalife L, Abdel-Latif R, Faour WH. Ghrelin hormone a new molecular modulator between obesity and glomerular damage. Mol Biol Rep. 2023;50(12):10525–10533. doi: 10.1007/s11033–023–08866–8.
5.
Czaja-Stolc S, Potrykus M, Stankiewicz M, Kaska Ł, Małgorzewicz S. Pro-Inflammatory Profile of Adipokines in Obesity Contributes to Pathogenesis, Nutritional Disorders, and Cardiovascular Risk in Chronic Kidney Disease. Nutrients. 2022;14(7):1457. doi: 10.3390/nu14071457.
6.
Pinto KRD, Feckinghaus CM, Hirakata VN. Obesity as a predictive factor for chronic kidney disease in adults: systematic review and meta-analysis. Braz J Med Biol Res. 2021;54(4):e10022. doi: 10.1590/1414–431X202010022.
7.
Lin X, Li H. Obesity: Epidemiology, Pathophysiology, and Therapeutics. Front Endocrinol. 2021;12:706978. doi: 10.3389/fendo.2021.706978.
8.
Harhay MN, Kim Y, Moore K, Harhay MO, Katz R, Shlipak MG, Mattix-Kramer HJ. Modifiable kidney disease risk factors among nondiabetic adults with obesity from the Multi-Ethnic Study of Atherosclerosis. Obesity (Silver Spring). 2023;31(12):3056–3065. doi: 10.1002/oby.23883.
9.
Liu L, Wang Y, Zhang W, Chang W, Jin Y, Yao Y. Waist height ratio predicts chronic kidney disease: a systematic review and meta-analysis, 1998–2019. Arch Public Health. 2019;77:55. doi: 10.1186/s13690–019–0379–4.
10.
Safaei M, Sundararajan EA, Driss M, Boulila W, Shapi’i A. A systematic literature review on obesity: Understanding the causes & consequences of obesity and reviewing various machine learning approaches used to predict obesity. Comput Biol Med. 2021;136:104754. doi: 10.1016/j.compbiomed.2021.104754.
11.
World Health Organization. Regional Office for Europe, WHO European Regional Obesity: Report 2022.
12.
Alizadeh S, Esmaeili H, Alizadeh M, Daneshzad E, Sharifi L, Radfar H, Radaei MK. Metabolic phenotypes of obese, overweight, and normal weight individuals and risk of chronic kidney disease: a systematic review and meta-analysis. Arch Endocrinol Metab. 2019;63(4):427–437. doi: 10.20945/2359–3997000000149.
13.
Aydemir N, Pike MM, Alsouqi A, Headley SAE, Tuttle K, Evans EE, Milch CM, Moody KA, Germain M, Lipworth L, Himmelfarb J, Ikizler TA, Robinson-Cohen C. Effects of diet and exercise on adipocytokine levels in patients with moderate to severe chronic kidney disease. Nutr Metab Cardiovasc Dis. 2020;30(8):1375–1381. doi: 10.1016/j.numecd.2020.04.012.
14.
Miricescu D, Balan DG, Tulin A, Stiru O, Vacaroiu IA, Mihai DA, Popa CC, Enyedi M, Nedelea AS, Nica AE, Stefani C. Impact of adipose tissue in chronic kidney disease development (Review). Exp Ther Med. 2021;21(5):539. doi: 10.3892/etm.2021.9969.
15.
Ikizler TA, Robinson-Cohen C, Ellis C, Headley SAE, Tuttle K, Wood RJ, Evans EE, Milch CM, Moody KA, Germain M, Limkunakul C, Bian A, Stewart TG, Himmelfarb J. Metabolic Effects of Diet and Exercise in Patients with Moderate to Severe CKD: A Randomized Clinical Trial. J Am Soc Nephrol. 2018;29(1):250–259. doi: 10.1681/ASN.2017010020.
16.
Abdul Wahab R, Cohen RV, le Roux CW. Recent advances in the treatment of patients with obesity and chronic kidney disease. Ann Med. 2023;55(1):2203517. doi: 10.1080/07853890.2023.2203517.
17.
Zhao S, Li Y, Su C. Assessment of common risk factors of diabetes and chronic kidney disease: a Mendelian randomization study. Front Endocrinol (Lausanne). 2023;14:1265719. doi: 10.3389/fendo.2023.1265719.
18.
Bruci A, Tuccinardi D, Tozzi R, Balena A, Santucci S, Frontani R, Mariani S, Basciani S, Spera G, Gnessi L, Lubrano C, Watanabe M. Very Low-Calorie Ketogenic Diet: A Safe and Effective Tool for Weight Loss in Patients With Obesity and Mild Kidney Failure. Nutrients. 2020;12(2):333. doi: 10.3390/nu12020333.
19.
Conley MM, McFarlane CM, Johnson DW, Kelly JT, Campbell KL, MacLaughlin HL. Interventions for weight loss in people with chronic kidney disease who are overweight or obese. Cochrane Database Syst Rev. 2021;3(3):CD013119. doi: 10.1002/14651858.
20.
Kassam AF, Mirza A, Kim Y, Hanseman D, Woodle ES, Quillin RC 3rd, Johnson BL, Govil A, Cardi M, Schauer DP, Smith EP, Diwan TS. Long-term outcomes in patients with obesity and renal disease after sleeve gastrectomy. Am J Transplant. 2020;20(2):422–429. doi: 10.1111/ajt.15650.
21.
Cohen RV, Pereira TV, Aboud CM, Petry TBZ, Lopes Correa JL, Schiavon CA, Pompílio CE, Pechy FNQ, da Costa Silva ACC, de Melo FLG, Cunha da Silveira LP, de Paris Caravatto PP, Halpern H, Monteiro FLJ, da Costa Martins B, Kuga R, Palumbo TMS, Docherty NG, le Roux CW. Effect of Gastric Bypass vs Best Medical Treatment on Early-Stage Chronic Kidney Disease in Patients With Type 2 Diabetes and Obesity: A Randomized Clinical Trial. JAMA Surg. 2020;155(8):e200420. doi: 10.1001/jamasurg.2020.0420.
22.
Pané A, Claro M, Molina-Andujar A, Olbeyra R, Romano-Andrioni B, Boswell L, Montagud-Marrahi E, Jiménez A, Ibarzabal A, Viaplana J, Ventura-Aguiar P, Amor AJ, Vidal J, Flores L, de Hollanda A. Bariatric Surgery Outcomes in Patients with Chronic Kidney Disease. J Clin Med. 2023;12(18):6095. doi: 10.3390/jcm12186095.
23.
Cohen RV, Pereira TV, Aboud CM, Zanata Petry TB, Lopes Correa JL, Schiavon CA, Pompílio CE, Quirino Pechy FN, Calmon da Costa Silva AC, Cunha da Silveira LP, Paulo de Paris Caravatto P, Halpern H, de Lima Jacy Monteiro F, da Costa Martins B, Kuga R, Sarian Palumbo TM, Friedman AN, le Roux CW. Gastric bypass versus best medical treatment for diabetic kidney disease: 5 years follow up of a singlecentre open label randomised controlled trial. EClinicalMedicine. 2022;53:101725. doi: 10.1016/j.eclinm.2022.101725.
24.
Perkovic V, Jardine MJ, Neal B, Bompoint S, Heerspink HJL, Charytan DM, Edwards R, Agarwal R, Bakris G, Bull S, Cannon CP, Capuano G, Chu PL, de Zeeuw D, Greene T, Levin A, Pollock C, Wheeler DC, Yavin Y, Zhang H, Zinman B, Meininger G, Brenner BM, Mahaffey KW; CREDENCE Trial Investigators. Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy. N Engl J Med. 2019;380(24):2295–2306. doi: 10.1056/NEJMoa1811744.
25.
Heerspink HJL, Stefánsson BV, Correa-Rotter R, Chertow GM,
Greene T, Hou FF, Mann JFE, McMurray JJV, Lindberg M, Rossing P,
Sjöström CD, Toto RD, Langkilde AM, Wheeler DC; DAPA-CKD Trial Committees and Investigators. Dapagliflozin in Patients with Chronic Kidney Disease. N Engl J Med. 2020;383(15):1436–1446. doi: 10.1056/ NEJMoa2024816.
26.
Chin MP, Bakris GL, Block GA, Chertow GM, Goldsberry A, Inker
LA, Heerspink HJL, O’Grady M, Pergola PE, Wanner C, Warnock
DG, Meyer CJ. Bardoxolone Methyl Improves Kidney Function in
Patients with Chronic Kidney Disease Stage 4 and Type 2 Diabetes: Post-Hoc Analyses from Bardoxolone Methyl Evaluation in Patients with Chronic Kidney Disease and Type 2 Diabetes Study. Am J Nephrol. 2018;47(1):40–47. doi: 10.1159/000486398.
27.
de Zeeuw D, Akizawa T, Agarwal R, Audhya P, Bakris GL, Chin M,
Krauth M, Lambers Heerspink HJ, Meyer CJ, McMurray JJ, Parving
HH, Pergola PE, Remuzzi G, Toto RD, Vaziri ND, Wanner C, Warnock
DG, Wittes J, Chertow GM. Rationale and trial design of Bardoxolone Methyl Evaluation in Patients with Chronic Kidney Disease and Type 2 Diabetes: the Occurrence of Renal Events (BEACON). Am J Nephrol. 2013;37(3):212–22. doi: 10.1159/000346948.
28.
Chertow GM, Appel GB, Block GA, Chin MP, Coyne DW, Goldsberry A, Kalantar-Zadeh K, Meyer CJ, Molitch ME, Pergola PE, Raskin P, Silva AL, Spinowitz B, Sprague SM, Rossing P. Effects of bardoxolone methyl on body weight, waist circumference and glycemic control in obese patients with type 2 diabetes mellitus and stage 4 chronic kidney disease. J Diabetes Complications. 2018;32(12):1113–1117. doi: 10.1016/j. jdiacomp.2018.09.005.
| eISSN: | 1898-7516 |
| ISSN: | 1898-2395 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
