‘Complex’ relationship between obesity, CKD requires early, aggressive treatment
Click Here to Manage Email Alerts
Increased fat mass, particularly visceral adiposity, promotes kidney disease generation and progression through direct and indirect mechanisms, and pharmacologic treatment is necessary to avoid adverse outcomes, according to a speaker.
“The direct mechanisms that you and I treat in the office everyday are BP, cholesterol and diabetes,” Matthew Weir, MD, professor and chief of the division of nephrology at University of Maryland School of Medicine, said during a presentation at the World Congress on Insulin Resistance, Diabetes & Cardiovascular Disease. “The major indirect mechanisms, which are vasculotoxic, require specific therapies addressing the renin angiotensin aldosterone system, the sympathetic nervous system and, of course, inflammation, which we see in so many of our patients with overweight.”
Source: Adobe Stock
Obesity as independent risk factor
Obesity and chronic kidney disease are major public health problems; data show that even people without diabetes or hypertension have a threefold increased risk for CKD if they have overweight by age 20 years, Weird said. Higher baseline BMI has remained an independent risk factor for end-stage renal disease, even after adjusting for a patient’s BP and diabetes status. There is also a much higher frequency of albuminuria in people with overweight or obesity.
Yet, clinicians tend to treat the side effects of obesity rather than the underlying disease process, Weir said.
“The interplay between all of these factors is quite complex, because many factors lead to obesity,” Weir said. “There are now many new options to help us. Overweight people should be screened [for CKD].”
Available treatments promising
Low-calorie diets are associated with improved estimated glomerular filtration rate (eGFR) and albuminuria, and a low-sodium diet is associated with less glomerular hyperfiltration in people with overweight. Adherence to a healthy lifestyle is associated with lower all-cause mortality in people with CKD, whereas a sedentary lifestyle is associated with prevalent CKD, Weir said. The downside is such nonpharmacologic options can be difficult to follow in the long-term, Weir said.
“The bottom line is we need pharmacologic treatment that is going to help these people,” Weir said. “Lifestyle adjustments are very difficult to make.”
The available literature looks “quite rosy” with respect to drugs that can block the renin angiotensin system, Weir said. ACE inhibition has been shown to reduce the rate of renal events in people with obesity with CKD more effectively than in people without obesity. Additionally, mineralocorticoid receptor blockers, SGLT2 inhibitors and GLP-1 receptor agonists are also associated with better control of cardiometabolic-associated conditions as well as sustained weight loss.
Bariatric surgery offers another option for people with obesity and CKD; however, many patients prefer drugs over surgery, Weir said.
“Increased central fat mass is associated with glomerular capillary hypertension, albuminuria and glomerulosclerosis, and that is the key message that we need to pay attention to,” Weir said.
Collapse
Weir M. Session 15: Obesity and Dysmetabolism as Risk Factors for CKD. Presented at: World Congress on Insulin Resistance, Diabetes & Cardiovascular Disease; Dec. 1-3, 2022; Universal City, California (hybrid meeting).
Read more about
Click Here to Manage Email Alerts