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Obesity In Kidney Disease.

P. Stenvinkel
Published 2010 · Medicine

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The worldwide obesity epidemic carries not only a considerable increased risk for comorbid complications, such as hypertension, type 2 diabetes, nonalcoholic fatty liver, osteoarthritis, cancer, psychosocial complications, dyslipidemia, cardiovascular disease, and sleep apnea, but also for chronic kidney disease (CKD) and its progression to end-stage renal disease (ESRD). Proper prevention and treatment of obesity in the general population may be one of the most relevant action points in order to prevent the global increase of CKD. Since body mass index is a poor estimate of fat mass distribution in ESRD, nephrologists need to learn to use other measures of fat mass distribution, such as waist-hip ratio. Obesity is associated with better outcomes in inflamed dialysis patients, and current evidence indicates that although the risk of postoperative complications are increased, the outcome of obese patients undergoing renal transplantation are better than in obese dialysis patients who remain on dialysis. The current model that overeating of carbohydrates mixed with a sedentary lifestyle and a resulting asymmetry between energy in and out as the only explanation of the obesity epidemic have been confronted. Recent studies suggest that more complicated coexisting transformations, such as changes in the epigenome, modified neurotransmitter activity, gut dysbiosis, virus infections, and metabolic changes provoked by specific nutrients, may also contribute to overweight status.
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