Chronic Kidney Disease and Obesity.
Obesity is an independent driver of CKD development and progression through hemodynamic, inflammatory, and metabolic mechanisms that produce obesity-related glomerulopathy, though once advanced CKD is established obesity is paradoxically associated with improved survival.
Background
The prevalence of obesity has nearly tripled worldwide since 1975, and a growing body of evidence identifies it as a driver of chronic kidney disease progression. The mechanisms are complex and include hemodynamic changes with hyperfiltration, chronic inflammation, oxidative stress, insulin resistance, and activation of the renin-angiotensin-aldosterone system.
Key recommendations
Obesity-related kidney disease is characterized histologically by glomerulomegaly, often accompanied by localized and segmental glomerulosclerosis lesions, with microproteinuria as the main early clinical manifestation and nephrotic syndrome being rare. Weight loss through proper nutrition and exercise, RAAS blockade, and in selected morbidly obese patients bariatric surgery have protective effects, and emerging evidence supports SGLT2 inhibitors and GLP-1 receptor agonists for their combined weight and kidney benefits.
Clinical implications
Despite available interventions, a significant proportion of patients eventually progress to end-stage renal disease, underscoring the need to understand underlying mechanisms to develop new strategies to slow progression. Notably, in advanced CKD, particularly hemodialysis populations, higher body mass index is paradoxically associated with lower mortality, so weight-management decisions require individualized assessment balancing kidney protection against the risk of protein-energy wasting.
Category
Research
Source
Nephron
More from ASNRT News
Browse the latest news, society announcements, KDIGO guideline updates, and AJNT issue releases on the ASNRT newsroom.