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Effect of an Intensive Weight-Loss Lifestyle Intervention on Kidney Function: A Randomized Controlled Trial

2021; Karger Publishers; Volume: 52; Issue: 1 Linguagem: Inglês

10.1159/000513664

1421-9670

Andrés Díaz‐López, Nerea Becerra‐Tomás, V. Ruiz-García, Estefanía Toledo, Nancy Babió, Dolores Corella, Montserrat Fitó, Dora Romaguera, Jesús Vioqué, Ángel M. Alonso‐Gómez, Julia Wärnberǵ, J. Alfredo Martínéz, Luís Serra‐Majem, Ramón Estruch, Francisco J. Tinahones, José Lapetra, Xavier Pintó, Josep A. Tur, José López‐Miranda, Naomi Cano Ibáñez, Miguel Delgado‐Rodríguez, Pilar Matía‐Martín, Lidia Daimiel, José António de Paz Fernández, Josép Vidal, Clotilde Vázquez, Miguel Ruiz‐Canela, Mònica Bulló, José V. Sorlí, Albert Goday, Miquel Fiol, Manuela García de la Hera, Lucas Tojal‐Sierra, Napoleón Pérez‐Farinós, M. Ángeles Zulet, Almudena Sánchez‐Villegas, Emilio Sacanella, José Carlos Fernández‐García, José Manuel Santos‐Lozano, Miquel Gimenez-Gracia, María del Mar Bibiloni, Javier Díez‐Espino, Carolina Ortega‐Azorín, Olga Castañer, Marga Morey, Laura Torres‐Collado, Carolina Sorto Sanchez, Miguel Ángel Muñoz, Emilio Ros, Miguel Ángel Martínez‐González, Jordi Salas‐Salvadó,

Obesity, Physical Activity, Diet

Large randomized trials testing the effect of a multifactorial weight-loss lifestyle intervention including Mediterranean diet (MedDiet) on renal function are lacking. Here, we evaluated the 1-year efficacy of an intensive weight-loss intervention with an energy-reduced MedDiet (erMedDiet) plus increased physical activity (PA) on renal function.Randomized controlled "PREvención con DIeta MEDiterránea-Plus" (PREDIMED-Plus) trial is conducted in 23 Spanish centers comprising 208 primary care clinics. Overweight/obese (n = 6,719) adults aged 55-75 years with metabolic syndrome were randomly assigned (1:1) to an intensive weight-loss lifestyle intervention with an erMedDiet, PA promotion, and behavioral support (intervention) or usual-care advice to adhere to an energy-unrestricted MedDiet (control) between September 2013 and December 2016. The primary outcome was 1-year change in estimated glomerular filtration rate (eGFR). Secondary outcomes were changes in urine albumin-to-creatinine ratio (UACR), incidence of moderately/severely impaired eGFR (<60 mL/min/1.73 m2) and micro- to macroalbuminuria (UACR ≥30 mg/g), and reversion of moderately (45 to <60 mL/min/1.73 m2) to mildly impaired GFR (60 to <90 mL/min/1.73 m2) or micro- to macroalbuminuria.After 1 year, eGFR declined by 0.66 and 1.25 mL/min/1.73 m2 in the intervention and control groups, respectively (mean difference, 0.58 mL/min/1.73 m2; 95% CI: 0.15-1.02). There were no between-group differences in mean UACR or micro- to macroalbuminuria changes. Moderately/severely impaired eGFR incidence and reversion of moderately to mildly impaired GFR were 40% lower (HR 0.60; 0.44-0.82) and 92% higher (HR 1.92; 1.35-2.73), respectively, in the intervention group.The PREDIMED-Plus lifestyle intervention approach may preserve renal function and delay CKD progression in overweight/obese adults.