Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana;, †Department of Environmental Health, Indiana University, Bloomington, Indiana, ‡Department of Medicine, Fayette Regional Health System, Connersville, Indiana.
Clin J Am Soc Nephrol. 2013 Nov;8(11):1892-8. doi: 10.2215/CJN.04010413. Epub 2013 Aug 8.
Obesity precedes and is strongly linked to the development of type 2 diabetic nephropathy in most patients, yet little is known about the effects of weight reduction on this disease. This study aimed to establish proof of concept for the hypothesis that weight reduction ameliorates diabetic nephropathy.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Six obese individuals with advanced diabetic nephropathy (estimated GFR <40 ml/min per 1.73 m(2), urine albumin excretion >30 mg/d) currently taking a renin-aldosterone axis inhibitor underwent a 12-week very low calorie ketogenic weight reduction diet with encouragement of exercise between March and September 2012. Albuminuria and other parameters of kidney health were the main outcome measures.
There was a 12% reduction in weight (median 118.5 versus 104.3 kg, P=0.03). The intervention was associated with a 36% reduction in albuminuria that did not reach statistical significance (2124 versus 1366 mg/24 h, P=0.08) and significant reductions in the filtration markers serum creatinine (3.54 versus 3.13 mg/dl, P<0.05) and cystatin C (2.79 versus 2.46 mg/l, P<0.05). Improvements were also noted for the diabetes markers fasting glucose (166 versus 131 mg/dl, P<0.05), fasting insulin (26.9 versus 10.4 μU/ml, P<0.05), and insulin resistance (9.6 versus 4.2, P=0.03). Physical function, general health, and the number of diabetes medications also showed statistically significant signs of improvement.
After a short-term intensive weight reduction intervention in patients with advanced diabetic nephropathy, improvements were observed in markers of glomerular filtration, diabetes status, and risk factors for kidney disease progression, as well as other general indicators of health and well-being.
肥胖是大多数 2 型糖尿病肾病患者发生和发展的前提，且与该疾病密切相关，但目前对于减轻体重对该疾病的影响知之甚少。本研究旨在为体重减轻可改善糖尿病肾病这一假说提供初步证据。
设计、地点、参与者和测量：2012 年 3 月至 9 月，6 例患有晚期糖尿病肾病（估算肾小球滤过率<40ml/min·1.73m²，尿白蛋白排泄量>30mg/d）的肥胖个体在服用肾素-血管紧张素-醛固酮轴抑制剂的同时接受为期 12 周的极低热量生酮减肥饮食，并鼓励其进行锻炼。主要观察指标为蛋白尿及其他肾脏健康参数。
体重下降 12%（中位数 118.5 千克比 104.3 千克，P=0.03）。该干预措施与蛋白尿减少 36%相关（2124 毫克/24 小时比 1366 毫克/24 小时，P=0.08），且血清肌酐（3.54 毫克/分升比 3.13 毫克/分升，P<0.05）和胱抑素 C（2.79 毫克/升比 2.46 毫克/升，P<0.05）等滤过标志物显著降低。糖尿病标志物如空腹血糖（166 毫克/分升比 131 毫克/分升，P<0.05）、空腹胰岛素（26.9 微单位/毫升比 10.4 微单位/毫升，P<0.05）和胰岛素抵抗（9.6 比 4.2，P=0.03）也有所改善。身体机能、总体健康状况以及糖尿病药物的使用数量也有显著改善。
在晚期糖尿病肾病患者中进行短期强化减肥干预后，肾小球滤过标志物、糖尿病状态和肾脏疾病进展的危险因素以及其他一般健康和幸福感指标均有改善。
