Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
Department of Gastroenterology and Nutrition, Geisinger, Danville, Pennsylvania.
Am J Kidney Dis. 2023 Dec;82(6):762-771. doi: 10.1053/j.ajkd.2023.04.009. Epub 2023 Jul 25.
The prevalence of obesity in the United States and across the world continues to climb, imparting increased risk of chronic disease. This impact is doubly felt in nephrology because obesity not only increases the risk of chronic kidney disease (CKD) but also exacerbates existing cardiovascular morbidity and mortality. The role of medical weight loss therapy in CKD has been debated, but increasing evidence suggests that intentional weight loss is protective against adverse kidney and cardiovascular outcomes. This may be particularly true with the advent of novel pharmacotherapies taking advantage of the incretin system, resulting in weight loss approaching that seen with surgical interventions. Moreover, these novel therapies have repeatedly demonstrated protective effects on the cardiovascular system. Here, we review the impact of obesity and weight loss on CKD, and the biological basis and clinical evidence for incretin therapy. This perspective provides recommended prescribing practices as a practical tool to engage nephrologists and patients with CKD in the treatment of obesity-related morbidity.
肥胖在美国和全球的流行率持续攀升，增加了患慢性病的风险。这种影响在肾病学中更为明显，因为肥胖不仅增加了慢性肾脏病 (CKD) 的风险，还加剧了现有的心血管发病率和死亡率。医学减肥疗法在 CKD 中的作用一直存在争议，但越来越多的证据表明，有意减肥对肾脏和心血管不良结局具有保护作用。随着利用肠促胰岛素系统的新型药物治疗的出现，这种情况可能更为明显，其减肥效果接近手术干预。此外，这些新型疗法已反复证明对心血管系统具有保护作用。在这里，我们回顾了肥胖和减肥对 CKD 的影响，以及肠促胰岛素治疗的生物学基础和临床证据。这种观点提供了推荐的处方实践，作为一种实用工具，使肾病学家和 CKD 患者参与肥胖相关发病率的治疗。
