Pommer Wolfgang
Department of Nephrology, The First Affiliated Hospital of Jinan University, Guangzhou, China.
Kuratorium für Dialyse und Nierentransplantation, KfH-Bildungszentrum, Neu-Isenburg, Germany.
Kidney Dis (Basel). 2018 Nov;4(4):199-204. doi: 10.1159/000490247. Epub 2018 Jul 12.
Obesity is increasing worldwide and has become a nontraditional risk factor in chronic kidney disease (CKD).
Obesity-related nephropathy may aggravate renal complications of the metabolic syndrome and progress to advanced CKD stages, while obesity in early stages of CKD is clearly related to the development of kidney disease. A high body mass index (BMI) in advanced CKD stages and dialysis is an advantage for survival (so called "obesity paradox"). A high lean body to fat mass index indicates a beneficial state of body composition. In contrast, loss of muscle mass with increasing fat mass causes "sarcopenia obesity," which is related to unfavorable outcomes in renal replacement therapy. Obesity (BMI > 30-35) in renal transplant recipients is associated with a higher risk of complications such as delayed graft function, increased rates of rejection, and graft loss. While conservative management of morbid obesity is failing in most cases, bariatric surgery seems to be an option in some cases to improve renal complications in the early stage of CKD or in transplant candidates.
In conclusion, obesity is increasingly prevalent among CKD patients. Adequate management with respect to the specific role of obesity in different stages of CKD should be integrated in routine renal care.
肥胖在全球范围内呈上升趋势，已成为慢性肾脏病（CKD）的非传统危险因素。
肥胖相关肾病可能会加重代谢综合征的肾脏并发症，并进展至晚期CKD阶段，而CKD早期的肥胖与肾病的发生明显相关。晚期CKD阶段及透析时较高的体重指数（BMI）对生存是一种优势（即所谓的“肥胖悖论”）。较高的瘦体重与脂肪量指数表明身体成分处于有益状态。相反，随着脂肪量增加肌肉量减少会导致“肌少症肥胖”，这与肾脏替代治疗的不良结局相关。肾移植受者肥胖（BMI>30 - 35）与诸如移植肾功能延迟、排斥反应发生率增加及移植肾丢失等并发症的较高风险相关。虽然大多数情况下对病态肥胖的保守治疗无效，但在某些情况下，减肥手术似乎是改善CKD早期或移植候选者肾脏并发症的一种选择。
总之，肥胖在CKD患者中越来越普遍。应将针对肥胖在CKD不同阶段的特定作用的适当管理纳入常规肾脏护理中。
