St. Joseph's Hospital, HealthEast Care System, University of Minnesota School of Public Health, Minneapolis, MN, USA.
Nephrol Dial Transplant. 2010 Apr;25(4):1173-83. doi: 10.1093/ndt/gfp640. Epub 2009 Nov 27.
Obesity is a risk factor for the progression of chronic kidney disease (CKD). The impact of weight loss on proteinuria and renal function is less clear. We aimed to determine the effect of intentional weight loss on proteinuria and kidney function.
Three bibliographic databases including Medline, Cochrane and SCUPOS as well as reference list of articles were searched. We included randomized and non-randomized controlled trials as well as single-arm trials published in English through May 2009 which examined urinary protein among obese or overweight adults before and after weight loss interventions including dietary restriction, exercise, anti-obesity medications and bariatric surgery. Study characteristics and methodological quality of trials were assessed.
Five hundred twenty-two subjects from five controlled and eight uncontrolled trials were included. Weight loss interventions were associated with decreased proteinuria and microalbuminuria by 1.7 g [95% confidence interval (95% CI), 0.7 to 2.6 g] and 14 mg (95% CI, 11 to 17 mg), respectively (P < 0.05). Meta-regression showed that, independent of decline in mean arterial pressure, each 1 kg weight loss was associated with 110 mg (95% CI, 60 to 160 mg, P < 0.001) decrease in proteinuria and 1.1 mg (95% CI, 0.5 to 2.4 mg, P = 0.011) decrease in microalbuminuria, respectively. The decrease was observed across different designs and methods of weight loss. Only bariatric surgery resulted in a significant decrease in creatinine clearance.
Weight loss is associated with decreased proteinuria and microalbuminuria. There were no data evaluating the durability of this decrease or the effect of weight loss on CKD progression.
肥胖是慢性肾脏病（CKD）进展的一个危险因素。减轻体重对蛋白尿和肾功能的影响尚不清楚。我们旨在确定有目的的体重减轻对蛋白尿和肾功能的影响。
检索了包括 Medline、Cochrane 和 SCUPOS 在内的 3 个文献数据库以及文章的参考文献列表。我们纳入了 2009 年 5 月前发表的英文随机和非随机对照试验以及单臂试验，这些试验检查了肥胖或超重成年人在减肥干预前后的尿蛋白，减肥干预包括饮食限制、运动、减肥药和减肥手术。评估了试验的研究特征和方法学质量。
共有来自 5 项对照和 8 项非对照试验的 522 名患者纳入本研究。减肥干预与蛋白尿和微量白蛋白尿分别减少 1.7 g（95%可信区间 95%CI，0.7 至 2.6 g）和 14 mg（95%CI，11 至 17 mg）（P < 0.05）。Meta 回归分析表明，独立于平均动脉压下降，每减轻 1 kg 体重与蛋白尿减少 110 mg（95%CI，60 至 160 mg，P < 0.001）和微量白蛋白尿减少 1.1 mg（95%CI，0.5 至 2.4 mg，P = 0.011）相关。这种下降在不同的设计和减肥方法中都观察到了。只有减肥手术才能显著降低肌酐清除率。
体重减轻与蛋白尿和微量白蛋白尿减少有关。没有数据评估这种减少的持久性或体重减轻对 CKD 进展的影响。
