Ahn Shin Young, Kim Dong Ki, Han Seung Seok, Park Jung Hwan, Shin Sung Joon, Lee Sang Ho, Choi Bum Soon, Lim Chun Soo, Kim Suhnggwon, Chin Ho Jun
Department of Internal Medicine, Korea University Medical Center Guro Hospital, Seoul, Korea.
Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Kidney Res Clin Pract. 2018 Mar;37(1):49-58. doi: 10.23876/j.krcp.2018.37.1.49. Epub 2018 Mar 31.
Weight reduction is a lifestyle intervention that has been introduced for prevention and management of chronic kidney disease (CKD). We investigate the additive anti-proteinuric effect of weight reduction on the usage of angiotensin II receptor blockers (ARBs) and its potential mechanisms in hypertensive CKD patients.
This study is a subanalysis of data from an open-label, randomized, controlled clinical trial. Among the 235 participants, 227 were assigned to subgroups according to changes in body weight.
Fifty-eight participants (25.6%) were assigned to group 1 (≥1.5% decrease in body weight after 16 weeks), 32 participants (14.1%) were assigned to group 2 (1.5-0.1% decrease in body weight), and 136 participants (59.9%) were assigned to group 3 (≥ 0.0% increase in body weight). Characteristics at enrollment were not different among the three groups, but mean differences in weight and percent changes in urinary sodium excretion over the period were statistically different ( < 0.001 and = 0.017). Over the study period, unintentional weight loss independently increased the probability of reduced albuminuria (group 1, relative risk 6.234, 95% confidence interval 1.913-20.315, = 0.002). Among urinary cytokines, only podocalyxin level decreased significantly in participants who lost weight ( = 0.013).
We observed that weight loss had an additive effect on the anti-proteinuric effects of ARBs in nondiabetic hypertensive CKD patients, although it was minimal. An additive effect was shown in both obese and non-obese participants, and its possible mechanism is related to reduction of podocyte damage.
减重是一种已被用于慢性肾脏病（CKD）预防和管理的生活方式干预措施。我们研究了减重对血管紧张素II受体阻滞剂（ARB）使用的附加降蛋白尿作用及其在高血压CKD患者中的潜在机制。
本研究是一项开放标签、随机、对照临床试验数据的亚分析。在235名参与者中，227名根据体重变化被分配到亚组。
58名参与者（25.6%）被分配到第1组（16周后体重下降≥1.5%），32名参与者（14.1%）被分配到第2组（体重下降1.5 - 0.1%），136名参与者（59.9%）被分配到第3组（体重增加≥0.0%）。三组入组时的特征无差异，但在此期间体重的平均差异和尿钠排泄百分比变化在统计学上有差异（<0.001和 = 0.017）。在研究期间，非故意减重独立增加了蛋白尿减少的概率（第1组，相对风险6.234，95%置信区间1.913 - 20.315， = 0.002）。在尿细胞因子中，只有足细胞蛋白水平在体重减轻的参与者中显著下降（ = 0.
