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Bays HE, Fitch A, Christensen S, Burridge K, Tondt J. Anti-Obesity Medications and Investigational Agents: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022. OBESITY PILLARS (ONLINE) 2022; 2:100018. [PMID: 37990711 PMCID: PMC10662004 DOI: 10.1016/j.obpill.2022.100018] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 04/11/2022] [Indexed: 11/23/2023]
Abstract
Background This "Anti-Obesity Medications and Investigational Agents: An Obesity Medicine Association Clinical Practice Statement 2022" is intended to provide clinicians an overview of Food and Drug Administration (FDA) approved anti-obesity medications and investigational anti-obesity agents in development. Methods The scientific information for this Clinical Practice Statement (CPS) is based upon published scientific citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership. Results This CPS describes pharmacokinetic principles applicable to those with obesity, and discusses the efficacy and safety of anti-obesity medications [e.g., phentermine, semaglutide, liraglutide, phentermine/topiramate, naltrexone/bupropion, and orlistat, as well as non-systemic superabsorbent oral hydrogel particles (which is technically classified as a medical device)]. Other medications discussed include setmelanotide, metreleptin, and lisdexamfetamine dimesylate. Data regarding the use of combination anti-obesity pharmacotherapy, as well as use of anti-obesity pharmacotherapy after bariatric surgery are limited; however, published data support such approaches. Finally, this CPS discusses investigational anti-obesity medications, with an emphasis on the mechanisms of action and summary of available clinical trial data regarding tirzepatide. Conclusion This "Anti-Obesity Medications and Investigational Agents: An Obesity Medicine Association Clinical Practice Statement 2022" is one of a series of OMA CPSs designed to assist clinicians in the care of patients with pre-obesity/obesity.
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Affiliation(s)
- Harold E. Bays
- Louisville Metabolic and Atherosclerosis Research Center, University of Louisville School of Medicine, 3288 Illinois Avenue, Louisville, KY, 40213, USA
| | - Angela Fitch
- Assistant Professor of Medicine Harvard Medical School, Co-Director Massachusetts General Hospital Weight Center, Boston, MA, USA
| | - Sandra Christensen
- Integrative Medical Weight Management, 2611 NE 125th St, Suite 100B, Seattle, WA, 98125, USA
| | - Karli Burridge
- Enara Health, 16501 106th Court, Orland Park, IL, 60467, USA
- Gaining Health, 528 Pennsylvania Ave #708, Glen Ellyn, IL, 60137, USA
| | - Justin Tondt
- Department of Family and Community Medicine, Eastern Virginia Medical School, P.O. Box 1980, Norfolk, VA, 23501, USA
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Truche AS, Bailly S, Fabre O, Legrand R, Zaoui P. A Specific High-Protein Weight Loss Program Does Not Impair Renal Function in Patients Who Are Overweight/Obese. Nutrients 2022; 14:384. [PMID: 35057566 PMCID: PMC8780753 DOI: 10.3390/nu14020384] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/10/2022] [Accepted: 01/14/2022] [Indexed: 02/06/2023] Open
Abstract
Although high-protein diets appear to be the most efficient way to lose weight, concerns may arise about their innocuity on renal function. The objective of this study is to assess the impact of a weight loss program on renal function. A multicentric cohort-based study was performed using the RNPC© French national weight loss program. Patients with at least two creatinine measurements at the beginning of the program and at the end of the weight loss phase between 1 January 2016 and 1 July 2021 were included. Renal function was assessed by Modification of Diet in Renal Disease (MDRD) equation-based estimated glomerular filtration rate (eGFR). From 4394 patients with two creatinine measurements included, 1579 (35.9%) had normal eGFR (MDRD 90-120 mL/min/1.73 m2), 210 (4.8%) had hyperfiltration (MDRD > 120 mL/min/1.73 m2), 2383 (54.2%) had chronic kidney disease (CKD) grade 2 (MDRD 60-90 mL/min/1.73 m2), and 221 (5.0%) had CKD grade 3 (MDRD 30-60 mL/min/1.73 m2). Multivariable analyses showed no eGFR change for patients in initial CKD grade 2, normal eGFR and hyperfiltration, and a significant increase in CKD grade 3. The RNPC© program avoids renal function impairment during the two first phases, regardless of the initial eGFR.
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Affiliation(s)
| | - Sébastien Bailly
- HP2 Laboratory, Grenoble Alpes University, INSERM U1300 and Grenoble Alpes University Hospital, 38000 Grenoble, France
| | - Odile Fabre
- Groupe Éthique et Santé, Actiburo 1, Bâtiment A—100 Chemin de l’Aumône Vieille, 13400 Aubagne, France; (O.F.); (R.L.)
| | - Rémy Legrand
- Groupe Éthique et Santé, Actiburo 1, Bâtiment A—100 Chemin de l’Aumône Vieille, 13400 Aubagne, France; (O.F.); (R.L.)
| | - Philippe Zaoui
- Service de Néphrologie, Dialyse, Transplantation Rénale, Grenoble Alpes University Hospital, 38700 La Tronche, France;
- AGDUC, Meylan Dialysis Center, 38240 Meylan, France
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Gubina NV, Kupnovytska IH, Mishchuk VH, Markiv HD. Ghrelin Levels and Decreased Kidney Function in Patients with Early Stages of Chronic Kidney Disease Against the Background of Obesity. J Med Life 2020; 13:530-535. [PMID: 33456602 PMCID: PMC7803302 DOI: 10.25122/jml-2020-0152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/09/2020] [Indexed: 11/17/2022] Open
Abstract
The importance of kidney damage in obese patients is due to the increasing incidence of nephropathies associated with metabolic disorders, their predisposition to a progressive course of the disease, and the need to optimize early disease detection. The purpose of our work is to study the level of cystatin C, ghrelin, and their interrelation in patients with early stages (I-II) of chronic kidney disease (CKD) against the background of obesity. The indicators of daily microalbuminuria in patients of both groups were studied, and it was found that in patients with stage 2 CKD with obesity, it was 1.2 times higher than in patients with stage 1 CKD with obesity. Patients of the second group revealed a direct middle correlation between daily albuminuria and body mass index (BMI), which indicates deterioration in the functional state of the kidneys against the background of obesity. We obtained an increase in the serum concentration of cystatin C in stage 2 CKD with obesity, reflecting the state of glomerular filtration and the degree of renal function decrease. Correlation analysis showed a positive relation of cystatin C with increased urinary albumin excretion in both groups, plasma creatinine content, BMI, and age. Simultaneously with the increase in the level of cystatin C and the decrease in the glomerular filtration rate, there was an increase in ghrelin levels in stage 2 CKD and the progression of obesity, while such dependence was not seen in stage 1 CKD.
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Affiliation(s)
- Nataliia Vasylivna Gubina
- Department of Clinical Pharmacology and Pharmacotherapy, Ivano-Frankivsk National Medical University of Ministry of Health of Ukraine, Ivano-Frankivsk City, Ukraine
| | - Iryna Hryhorivna Kupnovytska
- Department of Clinical Pharmacology and Pharmacotherapy, Ivano-Frankivsk National Medical University of Ministry of Health of Ukraine, Ivano-Frankivsk City, Ukraine
| | - Vasyl Hryhorovych Mishchuk
- Department of Clinical Pharmacology and Pharmacotherapy, Ivano-Frankivsk National Medical University of Ministry of Health of Ukraine, Ivano-Frankivsk City, Ukraine
| | - Halyna Dmytrivna Markiv
- Communal Non-profit Enterprise “Central City Clinical Hospital” of Ivano-Frankivsk City Council, Ivano-Frankivsk City, Ukraine
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4
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Assessment of Kidney Function in Patients With Extreme Obesity: A Narrative Review. Ann Pharmacother 2020; 55:80-88. [DOI: 10.1177/1060028020935580] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objectives: To discuss the evidence and caveats associated with estimated and measured creatinine clearance (eClCr and mClCr) and glomerular filtration rate (eGFR and mGFR) assessments of kidney function in patients with more extreme forms of obesity. Data Sources: PubMed (1976 to mid-May 2020) was used, with bibliographies of retrieved articles searched for additional articles. Study Selection and Data Extraction: Articles using gold standard mGFR to evaluate eClCr, mClCr, and eGFR assessments of kidney function in patients with more extreme forms of obesity were included. Data Synthesis: The overestimation of GFR by mClCr is well established, but mClCr is an alternative to mGFR assessments for determining medication dosing in patients with extremes of body size or muscle mass, or in patients receiving narrow therapeutic index medications when eGFR is likely to be inaccurate. The vast majority of studies comparing eGFR assessments with gold standard indicators of kidney function were attempts to validate eGFR equations for diagnosing and staging chronic kidney disease (CKD). Relevance to Patient Care and Clinical Practice: For dosing medications in patients with stable kidney function and extreme obesity, a deindexed 4-variable Modification of Diet in Renal Disease or CKD Epidemiology Collaboration equation is an alternative to Cockcroft-Gault. Consistent use of the same equation by provider and between providers within any given setting is of paramount importance. Conclusions: In patients with extreme obesity and stable kidney function, eClCr or eGFR using deindexed values provides estimates of function for dosing adjustments of medications with elimination by the kidneys, but more research is needed with respect to the best size descriptor to use with estimating equations.
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Camargo MS, Oliveira MG, Mistro S, Rocha ICP, Santos CN, Castro CTD, Passos LCS. Estimated glomerular filtration rate and drug dose adjustment in patients in an intensive care unit in Brazil. BRAZ J PHARM SCI 2020. [DOI: 10.1590/s2175-97902020000117837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Affiliation(s)
- Sankar D Navaneethan
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX (S.D.N.).,Section of Nephrology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX (S.D.N.)
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8
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Abstract
BACKGROUND The reported prevalence of hypocalcemia after bariatric surgery ranges from 1% after Roux-en-Y gastric bypass (RYGB) to 25% after bilio-pancreatic diversion-duodenal switch (BPD-DS). OBJECTIVE We aimed to define the prevalence of post-operative hypocalcemia and identify clinical predisposing factors. SETTING The study was conducted in an Academic Medical Center, USA. METHODS Retrospective analysis of all patients undergoing bariatric surgery from May 2008 to December 2014 at Mayo Clinic Rochester, Minnesota was performed. Patients with revision surgeries were excluded. Hypocalcemia was defined as the lowest recorded serum calcium occurring at least 2 weeks post-operatively. RESULTS Nine hundred ninety-nine patients fulfilled the criteria above. After correction for serum albumin concentration, 36 patients had serum calcium ≤8.9 mg/dl. Mean serum calcium was 8.1 ± 0.6 mg/dl. The prevalence was 1.9% in the RYGB group, 9.3% in the sleeve gastrectomy (SG) group, and 10% in the BPD-DS group. In all three surgical types, patients with hypocalcemia had significantly lower serum albumin and serum 25 (OH) vitamin D concentrations when compared to their normocalcemic counterparts (P < 0.01). The presence of renal insufficiency and vitamin D deficiency was associated with the highest risk of developing hypocalcemia after surgery [OR 16.8 (6.45-47.7) and 7.1(2.9-17.3), respectively]. Pre-operative renal insufficiency increased the odds of developing hypocalcemia by 20-fold. CONCLUSIONS In our series, hypocalcemia was identified in 3.6% of patients undergoing all bariatric surgery. Patients who are predisposed to developing post-operative hypocalcemia, such as those with pre-operative renal impairment, or post-operative vitamin D deficiency and renal insufficiency, may benefit from increased surveillance and prevention strategies.
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Møller G, Rikardt Andersen J, Ritz C, P Silvestre M, Navas-Carretero S, Jalo E, Christensen P, Simpson E, Taylor M, Martinez JA, Macdonald I, Swindell N, Mackintosh KA, Stratton G, Fogelholm M, Larsen TM, Poppitt SD, Dragsted LO, Raben A. Higher Protein Intake Is Not Associated with Decreased Kidney Function in Pre-Diabetic Older Adults Following a One-Year Intervention-A Preview Sub-Study. Nutrients 2018; 10:nu10010054. [PMID: 29315212 PMCID: PMC5793282 DOI: 10.3390/nu10010054] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 12/27/2017] [Accepted: 01/03/2018] [Indexed: 12/28/2022] Open
Abstract
Concerns about detrimental renal effects of a high-protein intake have been raised due to an induced glomerular hyperfiltration, since this may accelerate the progression of kidney disease. The aim of this sub-study was to assess the effect of a higher intake of protein on kidney function in pre-diabetic men and women, aged 55 years and older. Analyses were based on baseline and one-year data in a sub-group of 310 participants included in the PREVIEW project (PREVention of diabetes through lifestyle Intervention and population studies in Europe and around the World). Protein intake was estimated from four-day dietary records and 24-hour urinary urea excretion. We used linear regression to assess the association between protein intake after one year of intervention and kidney function markers: creatinine clearance, estimated glomerular filtration rate (eGFR), urinary albumin/creatinine ratio (ACR), urinary urea/creatinine ratio (UCR), serum creatinine, and serum urea before and after adjustments for potential confounders. A higher protein intake was associated with a significant increase in UCR (p = 0.03) and serum urea (p = 0.05) after one year. There were no associations between increased protein intake and creatinine clearance, eGFR, ACR, or serum creatinine. We found no indication of impaired kidney function after one year with a higher protein intake in pre-diabetic older adults.
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Affiliation(s)
- Grith Møller
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, 1958 Copenhagen, Denmark.
| | - Jens Rikardt Andersen
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, 1958 Copenhagen, Denmark.
| | - Christian Ritz
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, 1958 Copenhagen, Denmark.
| | - Marta P Silvestre
- Human Nutrition Unit, School of Biological Sciences, University of Auckland, Auckland 1010, New Zealand.
| | - Santiago Navas-Carretero
- Centre for Nutrition Research, University of Navarra, Calle Lrunlrrea 1, 31008 Pamplona, Navarra, Spain.
- CIBERobn, Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, 28029 Madrid, Spain.
| | - Elli Jalo
- Department of Food and Environmental Sciences, University of Helsinki, 00014 Helsinki, Finland.
| | - Pia Christensen
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, 1958 Copenhagen, Denmark.
| | - Elizabeth Simpson
- School of Life Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, University Park, Nottingham NG7 2RD, UK.
| | - Moira Taylor
- School of Life Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, University Park, Nottingham NG7 2RD, UK.
| | - J Alfredo Martinez
- Centre for Nutrition Research, University of Navarra, Calle Lrunlrrea 1, 31008 Pamplona, Navarra, Spain.
- CIBERobn, Instituto de Salud Carlos III, C/Monforte de Lemos 3-5, 28029 Madrid, Spain.
- Institute IMDEA Food, Crta. De Canto Blanco 8, 28029 Madrid, Spain.
| | - Ian Macdonald
- School of Life Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, University Park, Nottingham NG7 2RD, UK.
| | - Nils Swindell
- School of Sport and Exercise Sciences, A-STEM Research Centre, Swansea University, Singleton Park SA2 8PP, UK.
| | - Kelly A Mackintosh
- School of Sport and Exercise Sciences, A-STEM Research Centre, Swansea University, Singleton Park SA2 8PP, UK.
| | - Gareth Stratton
- School of Sport and Exercise Sciences, A-STEM Research Centre, Swansea University, Singleton Park SA2 8PP, UK.
| | - Mikael Fogelholm
- Department of Food and Environmental Sciences, University of Helsinki, 00014 Helsinki, Finland.
| | - Thomas M Larsen
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, 1958 Copenhagen, Denmark.
| | - Sally D Poppitt
- Human Nutrition Unit, School of Biological Sciences, University of Auckland, Auckland 1010, New Zealand.
| | - Lars O Dragsted
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, 1958 Copenhagen, Denmark.
| | - Anne Raben
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, 1958 Copenhagen, Denmark.
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10
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Higdon EA, Kimmons LA, Duhart BT, Hudson JQ. Disagreement in Estimates of Kidney Function for Drug Dosing in Obese Inpatients. J Pharm Pract 2017; 32:41-47. [PMID: 29105574 DOI: 10.1177/0897190017737895] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND: The Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations are used to estimate kidney function. However, utility has been questioned in the obese population. OBJECTIVE: To evaluate differences in estimates of kidney function in obese patients and implications for drug dosing. METHODS: This was a retrospective study of adult inpatients with a body mass index ≥30 kg/m2 and stable kidney function. Patients were categorized based on creatinine clearance (CrCl): group 1-CrCl ≥ 60 mL/min and group 2-CrCl 15 to 59 mL/min. Mean estimates of kidney function and recommended doses of 8 renally eliminated medications were compared. RESULTS: For the 166 patients included, mean estimates using CG, MDRD, and CKD-EPI for group 1 were 87 (23) mL/min, 91 (21) mL/min, and 96 (23) mL/min, respectively. Group 2 estimates were 42 (13) mL/min, 51 (15) mL/min, and 51 (16) mL/min, respectively. MDRD and CKD-EPI estimates were significantly higher than CG in 125 (75%) and 140 (84%) patients, respectively. Dose discrepancies were most often due to higher dose recommendations using MDRD or CKD-EPI compared to CG. CONCLUSION: Careful consideration of the method used to estimate kidney function, the method used for developing dosing recommendations, and the risk-benefit profile is warranted when designing drug regimens in obese individuals.
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Affiliation(s)
- Emily A Higdon
- 1 Department of Pharmacy, University of Kentucky HealthCare, Lexington, KY, USA
| | - Lauren A Kimmons
- 2 Department of Pharmacy, Methodist University Hospital, Memphis, TN, USA
| | - Benjamin T Duhart
- 3 Department of Clinical Pharmacy, The University of Tennessee, Memphis, TN, USA
| | - Joanna Q Hudson
- 3 Department of Clinical Pharmacy, The University of Tennessee, Memphis, TN, USA.,4 Department of Medicine (Nephrology), The University of Tennessee, Memphis, TN, USA
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11
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Donadio C, Moriconi D, Berta R, Anselmino M. Estimation of Urinary Creatinine Excretion and Prediction of Renal Function in Morbidly Obese Patients: New Tools from Body Composition Analysis. Kidney Blood Press Res 2017; 42:629-640. [DOI: 10.1159/000481630] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 06/06/2017] [Indexed: 11/19/2022] Open
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12
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Favre G, Anty R, Canivet C, Clément G, Ben-Amor I, Tran A, Gugenheim J, Gual P, Esnault VL, Iannelli A. Determinants associated with the correction of glomerular hyper-filtration one year after bariatric surgery. Surg Obes Relat Dis 2017; 13:1760-1766. [DOI: 10.1016/j.soard.2017.07.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 06/09/2017] [Accepted: 07/03/2017] [Indexed: 12/23/2022]
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Abstract
Chronic kidney disease (CKD) has a prevalence of approximately 13% and is most frequently caused by diabetes and hypertension. In population studies, CKD etiology is often uncertain. Some experimental and observational human studies have suggested that high-protein intake may increase CKD progression and even cause CKD in healthy people. The protein source may be important. Daily red meat consumption over years may increase CKD risk, whereas white meat and dairy proteins appear to have no such effect, and fruit and vegetable proteins may be renal protective. Few randomized trials exist with an observation time greater than 6 months, and most of these were conducted in patients with preexisting diseases that dispose to CKD. Results conflict and do not allow any conclusion about kidney-damaging effects of long-term, high-protein intake. Until additional data become available, present knowledge seems to substantiate a concern. Screening for CKD should be considered before and during long-term, high-protein intake.
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Affiliation(s)
- Anne-Lise Kamper
- Department of Nephrology, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark;
| | - Svend Strandgaard
- Department of Nephrology, Herlev Hospital, University of Copenhagen, 2730 Copenhagen, Denmark;
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14
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Motie M, Evangelista LS, Lombardo D, Hoi J, Horwich TB, Hamilton M, Fonarow GC. Effect of weight loss on renal function in overweight and obese patients with heart failure. Diabetes Metab Syndr 2017; 11:95-98. [PMID: 27381968 PMCID: PMC5182197 DOI: 10.1016/j.dsx.2016.06.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 06/19/2016] [Indexed: 11/17/2022]
Abstract
AIMS The effect of intentional weight loss on glomerular filtration rate (GFR) in overweight and obese patients with heart failure (HF), diabetes mellitus (DM) and/or metabolic syndrome (MS) has not been studied. The purpose of the present study is to assess the short term effects of intentional weight loss on renal function in this population. MATERIALS AND METHODS Fifty nine patients were recruited to participate in a 3-month intensive behavioral weight management intervention and received one of two standard structured energy-restricted meal plans (1200 or 1500kcal/day) based on their computed calorie deficit. Weight and renal function (serum creatinine, BUN and estimated glomerular filtration rate based on two formulas - Modification in Renal Disease Study (MDRD), and modified version of Cockcroft-Gault formula reported by Salazar Corcoran for obese patients (absolute and relative formulas) - were evaluated at baseline and at 3 months. RESULTS Participants had eGFR in the normal range at baseline and lost an average of 7.56±14.9 pounds (p<0.0001) over 3 months; however, there was no significant reduction in serum creatinine, BUN or eGFR. CONCLUSION This study provides evidence that intentional weight loss in overweight and obese patients with HF along with DM, and/or MS and normal baseline renal function does not adversely affect renal function overtime.
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Affiliation(s)
- Marjan Motie
- Program in Nursing Science, University of California Irvine, Irvine, CA, United States.
| | | | - Dawn Lombardo
- Clinical Heart Failure Program, Department of Medicine, University of California Irvine Medical Center, Irvine, CA, United States
| | - Josiah Hoi
- Program in Nursing Science, University of California Irvine, Irvine, CA, United States
| | - Tamara B Horwich
- Cardiology University of California at Los Angeles, David Geffen School of Medicine, Los Angeles, CA, United States
| | - Michele Hamilton
- Medicine/Cardiology UCLA, Heart Failure Program, Cedars-Sinai Heart Institute, Los Angeles, CA, United States
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Cardiology David Geffen School of Medicine, Los Angeles, CA, United States
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Smirnov AV, Kayukov IG, Rumyantsev AS. PROBLEM OF THE ASSESMENT OF GLOMERULAR FILTRATION RATE IN OBESITY. ACTA ACUST UNITED AC 2017. [DOI: 10.24884/1561-6274-2017-21-2-20-23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The article discusses the problem of choosing an adequate method of assessing glomerular filtration rate in overweight and obesity.
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Affiliation(s)
- A. V. Smirnov
- First Pavlov Saint Petersburg State Medical University
| | - I. G. Kayukov
- First Pavlov Saint Petersburg State Medical University
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Fouad M, Ismail MI, Gaballah A, Reyad E, ELdeeb S. Prevalence of obesity and risk of chronic kidney disease among young adults in Egypt. Indian J Nephrol 2016; 26:413-418. [PMID: 27942172 PMCID: PMC5131379 DOI: 10.4103/0971-4065.172597] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Increasing body mass index (BMI) has reached epidemic proportions globally and recently emerged as strong, independent risk factors for chronic kidney disease (CKD). We conducted this study to verify the prevalence of obesity and the associated risk of developing CKD among 3000 Egyptian students. The World Health Organization classification of BMI categorized study population into 1-5 groups, 1146 subjects with normal BMI (20-25), 951 subjects with BMI 25-29.9, 540 subjects with BMI 30-34.9, 225 with BMI 35-39.9, and 138 with BMI above 40. The participants were subjected to clinical examination, anthropometric measurements, laboratory investigation, including urinary albumin/creatinine ratio (ACR) and estimation of glomerular filtration rate (eGFR). The prevalence of overweight, obesity, and metabolic syndrome (MS) was 31.7%, 30.1%, and 16%, respectively. The prevalence of CKD among subjects with BMI >25 was 6.5%, almost all of them had BMI >35. ACR and eGFR rose progressively with increasing BMI. Elevated mean arterial pressure (MAP), high sensitivity C-reactive protein, and MS increased the risk of development of CKD. Moreover, MAP, waist to height ratio, and triglycerides to high-density lipoprotein ratios at levels of >95 mm Hg, >0.6, and >3 had sensitivity 91.7%, 88.4%, and 86.7%; and specificity 92.3%, 96.4%, and 96.5%, respectively to predict CKD. The prevalence of obesity among Egyptian young adults was high (30.1%) and was associated with increased the risk of CKD (6.5%).
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Affiliation(s)
- M. Fouad
- Department of Nephrology, Zagazig University Hospital, Zagazig, Egypt
| | - M. I. Ismail
- Department of Nephrology, Zagazig University Hospital, Zagazig, Egypt
| | - A. Gaballah
- Department of Clinical Pathology, Zagazig University Hospital, Zagazig, Egypt
| | - E. Reyad
- Nephrology Unit, Mansoura General Hospital, Egypt
| | - S. ELdeeb
- Department of Nephrology, Zagazig University Hospital, Zagazig, Egypt
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Tay J, Thompson CH, Luscombe-Marsh ND, Noakes M, Buckley JD, Wittert GA, Brinkworth GD. Long-Term Effects of a Very Low Carbohydrate Compared With a High Carbohydrate Diet on Renal Function in Individuals With Type 2 Diabetes: A Randomized Trial. Medicine (Baltimore) 2015; 94:e2181. [PMID: 26632754 PMCID: PMC5059023 DOI: 10.1097/md.0000000000002181] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To compare the long-term effects of a very low carbohydrate, high-protein, low saturated fat (LC) diet with a traditional high unrefined carbohydrate, low-fat (HC) diet on markers of renal function in obese adults with type 2 diabetes (T2DM), but without overt kidney disease.One hundred fifteen adults (BMI 34.6 ± 4.3 kg/m, age 58 ± 7 years, HbA1c 7.3 ± 1.1%, 56 ± 12 mmol/mol, serum creatinine (SCr) 69 ± 15 μmol/L, glomerular filtration rate estimated by the Chronic Kidney Disease Epidemiology Collaboration formula (eGFR 94 ± 12 mL/min/1.73 m)) were randomized to consume either an LC (14% energy as carbohydrate [CHO < 50 g/day], 28% protein [PRO], 58% fat [<10% saturated fat]) or an HC (53% CHO, 17% PRO, 30% fat [<10% saturated fat]) energy-matched, weight-loss diet combined with supervised exercise training (60 min, 3 day/wk) for 12 months. Body weight, blood pressure, and renal function assessed by eGFR, estimated creatinine clearance (Cockcroft-Gault, Salazar-Corcoran) and albumin excretion rate (AER), were measured pre- and post-intervention.Both groups achieved similar completion rates (LC 71%, HC 65%) and reductions in weight (mean [95% CI]; -9.3 [-10.6, -8.0] kg) and blood pressure (-6 [-9, -4]/-6[-8, -5] mmHg), P ≥ 0.18. Protein intake calculated from 24 hours urinary urea was higher in the LC than HC group (LC 120.1 ± 38.2 g/day, 1.3 g/kg/day; HC 95.8 ± 27.8 g/day, 1 g/kg/day), P < 0.001 diet effect. Changes in SCr (LC 3 [1, 5], HC 1 [-1, 3] μmol/L) and eGFR (LC -4 [-6, -2], HC -2 [-3, 0] mL/min/1.73 m) did not differ between diets (P = 0.25). AER decreased independent of diet composition (LC --2.4 [-6, 1.2], HC -1.8 [-5.4, 1.8] mg/24 h, P = 0.24); 6 participants (LC 3, HC 3) had moderately elevated AER at baseline (30-300 mg/24 h), which normalized in 4 participants (LC 2, HC 2) after 52 weeks.Compared with a traditional HC weight loss diet, consumption of an LC high protein diet does not adversely affect clinical markers of renal function in obese adults with T2DM and no preexisting kidney disease.
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Affiliation(s)
- Jeannie Tay
- From the Commonwealth Scientific and Industrial Research Organisation (CSIRO)-Food and Nutrition (JT, NDL-M, MN, GDB); Discipline of Medicine, University of Adelaide (JT, CHT, NDL-M, GAW); Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, University of South Australia, Adelaide, Australia (JDB); and Agency for Science, Technology and Research (A-STAR), Singapore, Singapore (JT)
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Navaneethan SD, Fealy CE, Scelsi AC, Arrigain S, Malin SK, Kirwan JP. A Trial of Lifestyle Modification on Cardiopulmonary, Inflammatory, and Metabolic Effects among Obese with Chronic Kidney Disease. Am J Nephrol 2015; 42:274-81. [PMID: 26495987 DOI: 10.1159/000441155] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 09/16/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND The feasibility and benefits of lifestyle intervention in chronic kidney disease (CKD) patients who are obese has not been well studied. We examined the early effects of an exercise plus weight loss intervention on body composition, exercise capacity, metabolic parameters and kidney function in obese subjects with CKD. METHODS Nine subjects (median age 57 years, body mass index (BMI) 43.9) underwent a lifestyle intervention program that included supervised aerobic exercise (i.e. ∼85% maximum heart rate) and dietary counseling (500 kcal reduction in daily caloric intake). Body composition (iDXA), exercise capacity (maximal oxygen consumption), quality of life, insulin resistance (Matsuda index), inflammation (high sensitivity C-reactive protein), adipokines (leptin and total adiponectin) and kidney function (iothalamate glomerular filtration rate) were measured at baseline and after 12 weeks of the intervention. Changes in parameters were compared using the Wilcoxon signed-rank test. RESULTS After 12 weeks of intervention, there was a significant decrease in BMI and fat mass (median -4.9 kg (25th-75th percentile -5.9 to -3.0)). There was a significant increase in exercise capacity (3.7 ml/kg/min (3.0-4.7)), along with improvements in insulin sensitivity (0.55 (0.43-1.2)), total adiponectin (780.9 μg/ml (262.1-1,497.1)) and leptin (-5.1 ng/ml (-14.5 to -3.3)). There were improvements in biomarkers of kidney disease very quality of life measures, but kidney function remained unchanged. CONCLUSION Lifestyle modification is feasible in obese patients with CKD and produces weight loss that is related to improvements in exercise capacity, insulin resistance and adipokines. Whether lifestyle-induced weight loss and fitness can be sustained and whether it will mediate improvements in kidney function over time merits further investigation.
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Affiliation(s)
- Sankar D Navaneethan
- Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Tex., USA
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19
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Abstract
The increasing prevalence of obesity in developed nations has far-reaching implications for medical toxicology. The management of obese patients is complicated by comorbid illnesses, changes in cardiovascular and respiratory physiology, alterations in pharmacokinetics, and a lack of studies to identify appropriate dosing for current therapeutics and antidotes. In this review article, we examine obesity-associated physiologic and pharmacokinetic changes that may increase the vulnerability of obese patients to overdose. Further research is needed to characterize the relationship between drug toxicity and obesity.
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Affiliation(s)
- Matthew Zuckerman
- University of Colorado, Anschutz Medical Campus, 12401 East 17th Avenue, Rm 759, Aurora, CO, 80045, USA,
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20
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Nguyen MT, Fong J, Ullah S, Lovell A, Thompson CH. Estimating glomerular filtration rate in obese subjects. Obes Res Clin Pract 2015; 9:152-7. [DOI: 10.1016/j.orcp.2014.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 04/01/2014] [Accepted: 04/20/2014] [Indexed: 10/25/2022]
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21
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Fiseha T, Kassim M, Yemane T. Chronic kidney disease and underdiagnosis of renal insufficiency among diabetic patients attending a hospital in Southern Ethiopia. BMC Nephrol 2014; 15:198. [PMID: 25511372 PMCID: PMC4277829 DOI: 10.1186/1471-2369-15-198] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 12/11/2014] [Indexed: 11/12/2022] Open
Abstract
Background Diabetic patients with chronic kidney disease (CKD), as defined by a reduced glomerular filtration rate (GFR), are at greater risk for cardiovascular and renal events and mortality. The aim of this study was to determine the prevalence of CKD among diabetic patients attending a hospital in southern Ethiopia, and to assess underdiagnosis of renal insufficiency among those with normal serum creatinine. Methods A total of 214 randomly selected diabetics attending the follow-up clinic at Butajira hospital of southern Ethiopia participated in this study during the period from September 1 to October 31, 2013. All patients completed an interviewer-administered questionnaire and underwent clinical assessment. The simplified Modification of Diet in Renal Disease (MDRD) and Cockroft-Gault (C-G) equations were used to estimate GFR (eGFR) from serum creatinine. Results CKD, defined as eGFR < 60 ml/min/1.73 m2, was present in 18.2% and 23.8% of the study participants according to the MDRD and Cockcroft-Gault (C-G) equations, respectively. Only 9.8% of the total participants, and 48.7% (for the MDRD) and 37.3% (for C-G) of those with eGFR <60 ml/min/1.73 m2 had abnormal serum creatinine values, i.e. > 1.5 mg/dl. Normal serum creatinine was observed in 90.2% of participants attending the hospital. A large proportion of participants ranging from 38.9-56.5% have shown to have mild to moderate renal insufficiency (stage 2–3 CKD) despite normal creatinine levels. CKD, eGFR < 60 ml/min/1.73 m2, was found in 10.4 and 16.9% of participants with normal serum creatinine using the MDRD and C-G equations, respectively. Conclusion CKD is present in no less than 18% of diabetics attending the hospital, but it is usually undiagnosed. A significant number of diabetics have renal insufficiency corresponding to stages 2–3 CKD despite normal creatinine levels. Therefore, GFR should be considered as an estimate of renal insufficiency, regardless of serum creatinine levels being in normal range.
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Affiliation(s)
- Temesgen Fiseha
- Department of Clinical Laboratory Science, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia.
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22
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Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Brethauer SA, Navaneethan SD, Aminian A, Pothier CE, Kim ESH, Nissen SE, Kashyap SR. Bariatric surgery versus intensive medical therapy for diabetes--3-year outcomes. N Engl J Med 2014; 370:2002-13. [PMID: 24679060 PMCID: PMC5451259 DOI: 10.1056/nejmoa1401329] [Citation(s) in RCA: 1131] [Impact Index Per Article: 113.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND In short-term randomized trials (duration, 1 to 2 years), bariatric surgery has been associated with improvement in type 2 diabetes mellitus. METHODS We assessed outcomes 3 years after the randomization of 150 obese patients with uncontrolled type 2 diabetes to receive either intensive medical therapy alone or intensive medical therapy plus Roux-en-Y gastric bypass or sleeve gastrectomy. The primary end point was a glycated hemoglobin level of 6.0% or less. RESULTS The mean (±SD) age of the patients at baseline was 48±8 years, 68% were women, the mean baseline glycated hemoglobin level was 9.3±1.5%, and the mean baseline body-mass index (the weight in kilograms divided by the square of the height in meters) was 36.0±3.5. A total of 91% of the patients completed 36 months of follow-up. At 3 years, the criterion for the primary end point was met by 5% of the patients in the medical-therapy group, as compared with 38% of those in the gastric-bypass group (P<0.001) and 24% of those in the sleeve-gastrectomy group (P=0.01). The use of glucose-lowering medications, including insulin, was lower in the surgical groups than in the medical-therapy group. Patients in the surgical groups had greater mean percentage reductions in weight from baseline, with reductions of 24.5±9.1% in the gastric-bypass group and 21.1±8.9% in the sleeve-gastrectomy group, as compared with a reduction of 4.2±8.3% in the medical-therapy group (P<0.001 for both comparisons). Quality-of-life measures were significantly better in the two surgical groups than in the medical-therapy group. There were no major late surgical complications. CONCLUSIONS Among obese patients with uncontrolled type 2 diabetes, 3 years of intensive medical therapy plus bariatric surgery resulted in glycemic control in significantly more patients than did medical therapy alone. Analyses of secondary end points, including body weight, use of glucose-lowering medications, and quality of life, also showed favorable results at 3 years in the surgical groups, as compared with the group receiving medical therapy alone. (Funded by Ethicon and others; STAMPEDE ClinicalTrials.gov number, NCT00432809.).
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Affiliation(s)
- Philip R Schauer
- From the Bariatric and Metabolic Institute (P.R.S., S.A.B., A.A.), Lerner Research Institute (J.P.K.), Heart and Vascular Institute (K.W., C.E.P., E.S.H.K., S.E.N.), Urological and Kidney Institute (S.D.N.), and Endocrinology Institute (S.R.K.), Cleveland Clinic, Cleveland; and Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School - both in Boston (D.L.B.)
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Jesudason D, Pedersen E, Clifton P. Utility of Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations in obese diabetic individuals before and after weight loss. Am J Kidney Dis 2014; 64:159-61. [PMID: 24685063 DOI: 10.1053/j.ajkd.2014.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Accepted: 02/06/2014] [Indexed: 11/11/2022]
Affiliation(s)
- David Jesudason
- CSIRO, Adelaide, Australia; University of Adelaide, Adelaide, Australia; The Queen Elizabeth Hospital, Adelaide, Australia.
| | - Eva Pedersen
- CSIRO, Adelaide, Australia; University of Adelaide, Adelaide, Australia; University of South Australia, Adelaide, Australia
| | - Peter Clifton
- CSIRO, Adelaide, Australia; University of Adelaide, Adelaide, Australia; University of South Australia, Adelaide, Australia
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Estimated glomerular filtration rate and albuminuria: true predictors of cardiovascular events in obese patients with type 2 diabetes? Wien Klin Wochenschr 2013; 125:629-33. [DOI: 10.1007/s00508-013-0422-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Accepted: 08/12/2013] [Indexed: 10/26/2022]
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Jesudason DR, Pedersen E, Clifton PM. Weight-loss diets in people with type 2 diabetes and renal disease: a randomized controlled trial of the effect of different dietary protein amounts. Am J Clin Nutr 2013; 98:494-501. [PMID: 23719550 DOI: 10.3945/ajcn.113.060889] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Higher-protein weight-loss diets (defined as >25% of energy as protein) are not recommended for individuals with type 2 diabetes because of their potential adverse effect on renal function. OBJECTIVE We aimed to examine the effect of such diets on renal function over 12 mo in people with type 2 diabetes and early renal disease. DESIGN Overweight and obese people with type 2 diabetes were screened to identify those with an albumin:creatinine ratio from 3 to 30 mg/mmol. Seventy-six subjects were randomly assigned to either a moderate-protein weight-loss diet or a standard-protein weight-loss diet for 12 mo. The primary endpoint was the change in renal function as assessed by the isotope glomerular filtration rate (GFR), estimated GFR, and cystatin C. Forty-five subjects (moderate protein: n = 21; standard protein: n = 24) completed the study. RESULTS The mean (±SE) weight loss was not different between diets at 9.7 ± 13.4 kg for the moderate-protein diet and 6.6 ± 7.1 kg for the standard-protein diet. There were no changes in renal function or albuminuria or blood pressure, although glycated hemoglobin was lowered with both diets. Changes in renal function were related to the baseline estimated GFR. Patients with stage 1-3 renal disease (<120 mL · min(-1) · 1.73 m(-2); n = 33) had an improvement in renal function, whereas patients with hyperfiltration (>120 mL · min(-1) · 1.73 m(-2); n = 12) had a decrease in the GFR. After adjustment for weight loss, the baseline GFR remained a significant predictor of outcomes with no effect of dietary treatment. An average difference in protein intake between diets of 19 ± 6 g/d was achieved. CONCLUSION Weight loss improved renal function, but differences in dietary protein had no effect. This trial was registered at the Australian and New Zealand Clinical Trial Register as ACTRN12608000045314.
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Affiliation(s)
- David R Jesudason
- Commonwealth Scientific and Industrial Research Organisation Animal Food and Health Science, Adelaide University, Centre for Clinical Research Excellence in Nutrition and University of South Australia, Adelaide, Australia
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26
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Lim YH, Kim YM, Shin J, Lee CH, Kim JH, Kim MK, Choi BY. Association of heart rate and left ventricular structure in a rural population in Korea. Clin Exp Hypertens 2013; 36:165-72. [PMID: 23786434 DOI: 10.3109/10641963.2013.804540] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract We investigated the association of heart rate (HR) and estimated glomerular filtration rate (eGFR) with left ventricular (LV) structure in a multi-rural cohort project in Korea. A total of 3215 subjects were analyzed for factors related to Echo-LV mass index (LVMI). eGFR was positively associated with both types of LVMI whereas HR was negatively associated with both. Odd ratios (ORs) (highest versus lowest quartiles) for LVMI by height(2.7) were significant for HR (OR: 0.441, p = 0.0035 in males; OR: 0.638, p = 0.0226 in females), and for eGFR (OR:1.643, p = 0.0145) in females. In conclusion, in addition to age, systolic blood pressure and body mass index, eGFR is positively associated with echocardiographic LVMI and HR is negatively associated with echocardiographic LVMI.
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Affiliation(s)
- Young-Hyo Lim
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine , Seoul , South Korea
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Chigutsa E, Meredith S, Wiesner L, Padayatchi N, Harding J, Moodley P, Mac Kenzie WR, Weiner M, McIlleron H, Kirkpatrick CMJ. Population pharmacokinetics and pharmacodynamics of ofloxacin in South African patients with multidrug-resistant tuberculosis. Antimicrob Agents Chemother 2012; 56:3857-63. [PMID: 22564839 PMCID: PMC3393408 DOI: 10.1128/aac.00048-12] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 04/29/2012] [Indexed: 11/20/2022] Open
Abstract
Despite the important role of fluoroquinolones and the predominant use of ofloxacin for treating multidrug-resistant tuberculosis in South Africa, there are limited data on ofloxacin pharmacokinetics in patients with multidrug-resistant tuberculosis, no ofloxacin pharmacokinetic data from South African patients, and no direct assessment of the relationship between ofloxacin pharmacokinetics and the MIC of ofloxacin of patient isolates. Our objectives are to describe ofloxacin pharmacokinetics in South African patients being treated for multidrug-resistant tuberculosis and assess the adequacy of ofloxacin drug exposure with respect to the probability of pharmacodynamic target attainment (area under the time curve/MIC ratio of at least 100). Sixty-five patients with multidrug-resistant tuberculosis were recruited from 2 hospitals in South Africa. We determined the ofloxacin MICs for the Mycobacterium tuberculosis isolates from baseline sputum specimens. Patients received daily doses of 800 mg ofloxacin, in addition to other antitubercular drugs. Patients underwent pharmacokinetic sampling at steady state. NONMEM was used for data analysis. The population pharmacokinetics of ofloxacin in this study has been adequately described. The probability of target attainment expectation in the study population was 0.45. Doubling the dose to 1,600 mg could increase this to only 0.77. The currently recommended ofloxacin dose appeared inadequate for the majority of this study population. Studies to assess the tolerability of higher doses are warranted. Alternatively, ofloxacin should be replaced with more potent fluoroquinolones.
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Affiliation(s)
- Emmanuel Chigutsa
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
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Blackburn GL, Magerowski G. The Impact of Renal Function on Outcomes of Bariatric Surgery. J Am Soc Nephrol 2012; 23:769-70. [DOI: 10.1681/asn.2012030306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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