Department MTTS, Clinica Medica, University of Trieste, Trieste, Italy.
J Ren Nutr. 2010 Sep;20(5 Suppl):S19-23. doi: 10.1053/j.jrn.2010.05.006.
Obesity is a global health threat because of its associated metabolic and cardiovascular complications. Metabolic and hemodynamic complications of obesity (insulin resistance and hyperglycemia, hypertension, atherogenic dyslipidemia) are often clustered in the metabolic syndrome, leading to high cardiovascular morbidity and mortality. In recent years, epidemiological studies have clearly indicated that both obesity and the metabolic syndrome are independent risk factors for chronic kidney disease and these associations are at least in part independent of diabetes and hypertension per se. Additional mechanisms associated with obesity and metabolic syndrome leading to reduced renal function may include altered levels of adipose tissue hormones, inflammation, and oxidative stress. The ongoing worldwide obesity epidemic is therefore likely to increase the number of patients with chronic uremia and features of the metabolic syndrome in the next few years. Moreover, the onset and maintenance of renal damage may worsen metabolic syndrome features including insulin resistance and hypertension, leading to potential vicious cycles with negative clinical effect. Further understanding of the interactions between obesity, metabolic syndrome, and chronic kidney disease represents a potential strategy to design more effective treatments aimed at reducing morbidity and mortality in uremic patients.
肥胖是一种全球性的健康威胁，因为它会引起代谢和心血管并发症。肥胖的代谢和血液动力学并发症（胰岛素抵抗和高血糖、高血压、致动脉粥样硬化性血脂异常）通常在代谢综合征中聚集，导致心血管发病率和死亡率高。近年来，流行病学研究清楚地表明，肥胖和代谢综合征都是慢性肾脏病的独立危险因素，这些关联至少部分独立于糖尿病和高血压本身。与肥胖和代谢综合征导致肾功能下降相关的其他机制可能包括脂肪组织激素水平改变、炎症和氧化应激。因此，全球肥胖症的流行很可能会在未来几年增加慢性尿毒症和代谢综合征特征的患者数量。此外，肾脏损害的发生和维持可能会使代谢综合征的特征恶化，包括胰岛素抵抗和高血压，从而导致潜在的恶性循环，产生负面的临床影响。进一步了解肥胖、代谢综合征和慢性肾脏病之间的相互作用，代表了设计更有效的治疗方法的潜在策略，旨在降低尿毒症患者的发病率和死亡率。
