Department of Nephrology, Geisinger, Danville, PA.
Department of Population of Health Sciences, Geisinger, Danville, PA; Kidney Health Research Institute, Geisinger, Danville, PA; Department of Nephrology, Geisinger, Danville, PA.
Am J Kidney Dis. 2021 Mar;77(3):427-439. doi: 10.1053/j.ajkd.2020.08.016. Epub 2020 Oct 16.
Obesity prevalence continues to increase worldwide, accompanied by a rising tide of hypertension, diabetes, and chronic kidney disease (CKD). Although body mass index is typically used to assess obesity in clinical practice, altered body composition (eg, reduced muscle mass and increased visceral adiposity) are common among patients with CKD. Weight loss achieved through behavioral modification or medications reduces albuminuria and in some cases slows the decline in estimated glomerular filtration rate. Use of medications that promote weight loss with favorable cardiovascular risk profiles should be promoted, particularly in patients with type 2 diabetes, obesity, and CKD. For those who fail to achieve weight loss through lifestyle modification, bariatric surgery should be considered because observational studies have shown reductions in risk for estimated glomerular filtration rate decline and kidney failure. Uncertainty persists on the risk to benefit ratio of intentional weight loss in patients with kidney failure due to the lack of prospective trials and limitations of observational data. Regardless, sleeve gastrectomy is increasingly being used for patients with kidney failure and severe obesity, with success in achieving sustained weight loss, improved access to kidney transplantation, and favorable posttransplantation outcomes. More research is needed assessing long-term cardiovascular and kidney outcomes of most weight loss medications.
肥胖患病率在全球范围内持续上升，伴随而来的是高血压、糖尿病和慢性肾脏病（CKD）发病率的上升。尽管在临床实践中通常使用体重指数来评估肥胖，但 CKD 患者中常存在身体成分改变（例如，肌肉量减少和内脏脂肪增加）。通过行为改变或药物治疗实现的体重减轻可减少蛋白尿，在某些情况下可减缓估计肾小球滤过率的下降。应提倡使用具有良好心血管风险特征并能促进体重减轻的药物，特别是在 2 型糖尿病、肥胖和 CKD 患者中。对于那些通过生活方式改变未能实现体重减轻的患者，应考虑进行减重手术，因为观察性研究表明，这种手术可降低估计肾小球滤过率下降和肾衰竭的风险。由于缺乏前瞻性试验和观察性数据的局限性，对于肾衰竭患者的体重减轻的风险获益比仍存在不确定性。无论如何，由于胃袖状切除术可成功实现持续减重、改善接受肾移植的机会和获得有利的移植后结果，因此越来越多地用于肾衰竭和严重肥胖患者。需要更多的研究来评估大多数减肥药物的长期心血管和肾脏结局。
