Effect of an intensive lifestyle intervention on cystatin C–based kidney function in adults with overweight and obesity: From the PREDIMED-Plus trial

IF 9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of Internal Medicine Pub Date : 2024-12-26 DOI:10.1111/joim.20038

José Ignacio Martínez-Montoro, Isabel Cornejo-Pareja, Andrés Díaz-López, Antoni Sureda, Estefania Toledo, Itziar Abete, Nancy Babio, Josep A. Tur, Miguel A. Martinez-Gonzalez, J. Alfredo Martínez, Montse Fitó, Jordi Salas-Salvadó, Francisco J. Tinahones, PREDIMED-Plus Investigators

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引用次数: 0

Abstract

Background

Large-scale trials evaluating a multicomponent lifestyle intervention aimed at weight loss on kidney function are lacking.

Methods

This was a post hoc analysis of the “PREvención con DIeta MEDiterránea-Plus” (PREDIMED-Plus) randomized controlled trial, including patients with overweight/obesity and metabolic syndrome, measured cystatin C and creatinine. Participants were randomly assigned (1:1) to an intensive weight loss lifestyle intervention (intervention group [IG]) consisting of an energy-restricted Mediterranean diet (MedDiet), physical activity promotion and behavioral support, or a control group (CG) receiving ad libitum MedDiet recommendations. The primary outcome was between-group differences in cystatin C–based kidney function (cystatin C–based estimated glomerular filtration rate—eGFRcys—and combined cystatin C–creatinine-based eGFR—eGFRcr-cys) change from baseline to 12 and 36 months. Secondary outcomes included between-group differences in creatinine-based eGFR (eGFRcr) and urinary albumin-to-creatinine ratio (UACR) change and the predictive capacity of these formulas at baseline for new-onset chronic kidney disease (CKD).

Results

A total of 1909 participants (65 ± 5 years, 54% men) were included. Twelve-month decline in eGFRcys, eGFRcr-cys, and eGFRcr was greater in the CG compared to the IG, with between-group differences of −1.77 mL/min/1.73 m² [95% confidence interval −2.92 to −0.63], −1.37 [−2.22 to −0.53], and −0.91 [−1.74 to −0.71], respectively. At 36 months, the decline in eGFRcr-cys and eGFRcr was greater in the CG. No between-group differences in UACR were found. Significant adjusted areas under the curve for baseline eGFRcys and eGFRcr-cys were observed for incident CKD at 36 months, which were similar to those for eGFRcr and UACR.

Conclusions

In older adults with overweight/obesity and metabolic syndrome, the PREDIMED-Plus intervention may be an optimal approach to preserve kidney function.

Abstract Image

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强化生活方式干预对超重和肥胖成人胱抑素c型肾功能的影响：来自PREDIMED-Plus试验

背景：目前还缺乏评估多组分生活方式干预减肥对肾功能影响的大规模试验。方法：这是对“PREvención con DIeta MEDiterránea-Plus”（PREDIMED-Plus）随机对照试验的事后分析，该试验包括超重/肥胖和代谢综合征患者，测量胱抑素C和肌酐。参与者被随机（1:1）分配到强化减肥生活方式干预组（干预组[IG]），包括限制能量的地中海饮食（MedDiet）、促进身体活动和行为支持，或对照组（CG）接受随意的MedDiet建议。主要结局是基于胱抑素c的肾功能（基于胱抑素c的肾小球滤过率- egfrcys和基于胱抑素c -肌酐的联合eGFR-eGFRcr-cys）从基线到12和36个月的变化的组间差异。次要结局包括基于肌酐的eGFR （eGFRcr）和尿白蛋白与肌酐比值（UACR）变化的组间差异，以及这些公式在基线时对新发慢性肾病（CKD）的预测能力。结果：共纳入1909例受试者（65±5岁，男性占54%）。与IG相比，CG组eGFRcys、eGFRcr-cys和eGFRcr在12个月内的下降幅度更大，组间差异分别为-1.77 mL/min/1.73 m2[95%可信区间-2.92至-0.63]、-1.37[-2.22至-0.53]和-0.91[-1.74至-0.71]。在36个月时，CG组eGFRcr-cys和eGFRcr的下降幅度更大。UACR组间无差异。基线eGFRcys和eGFRcr-cys曲线下的显著调整面积在36个月的CKD事件中被观察到，这与eGFRcr和UACR相似。结论：对于患有超重/肥胖和代谢综合征的老年人，PREDIMED-Plus干预可能是保护肾功能的最佳方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Internal Medicine 医学-医学：内科

CiteScore

22.00

自引率

0.90%

发文量

176

审稿时长

4-8 weeks

期刊介绍： JIM – The Journal of Internal Medicine, in continuous publication since 1863, is an international, peer-reviewed scientific journal. It publishes original work in clinical science, spanning from bench to bedside, encompassing a wide range of internal medicine and its subspecialties. JIM showcases original articles, reviews, brief reports, and research letters in the field of internal medicine.