Effects Of Weight Its Changes On Albuminuria And Renal Function

Background:The global obese population is skyrocketing.Obesity,even simple obesity,can cause kidney injury and increase the risk of chronic kidney disease.Severe obesity can directly lead to obesity related nephropathy.In addi-tion,obesity is closely related to changes in renal function.Previous studies have shown that treatments such as bariatric surgery,medications,and lifestyle inter-ventions have significantly improved renal function.Weight loss can improve glomerular filtration rate and urinary protein excretion.These conclusions were mainly derived from research on patients with extreme obesity,severe obesity,and simple obesity.Such studies are less concerned with new-onset albuminuria,aggravation of proteinuria,and reversal of proteinuria.Albuminuria is an early marker of glomerular injury and a predictor of progression to end-stage renal disease.It was also an independent risk factor for chronic diseases such as hy-pertension,diabetes,and cardiovascular disease and used as a target for the treat-ment.Because of the important role of albuminuria,timely detection and control of its development is particularly important.We tried to explore the effect of body weight and its change on albuminuria as well as renal function.We conducted a5-year cohort study in the physical examination population to explore the impact of obesity or overweight on kidney injury and whether weight loss will alleviate kidney injury,providing an evidence for the weight management strategies.Methods:Participants who had completed at least two or more physical examinations in the physical examination center of a third-class a hospital in Chengdu from September 2013 to September 2018,aged 18 to 80,had a baseline body mass index(BMI)≥18.5kg/m~2.Surgical weight loss,basal renal disease or eGFR<60ml/(min?1.73m~2),tumor,and pregnancy were excluded.The age,gen-der,height,weight and other basic information of the subjects were collected,as well as key biochemical indicators such as serum creatinine,urea nitrogen,uric acid and urinary albumin creatinine ratio(ACR).ACR≥30μg/mg was used as an indicator of albuminuria,and eGFR was calculated by the Chronic Kidney Dis-ease Epidemiology Collaboration(CKD-EPI)formula.The weight change rate(WCR)at the first and last physical examination was compared,and the changes of ACR and renal function were compared according to the changes of body weight.Results:A total of 81,510 persons with ACR were initially screened,and1,761 eligible subjects were gradually selected,including 1,410 males and 351females.During the follow-up period,667 people lost weight and 1,094 people did not lose weight.During the follow-up,59 new albuminuria patients were pre-sent;107 patients had albuminuria at baseline,and 30 had an ACR increase of30%or more.The proportion of hypertension and diabetes in baseline albuminu-ria were higher than those without albuminuria.Group(P<0.01),eGFR was also smaller than that of proteinuria-free group(P<0.01).Kaplan-Meier analysis showed that the cumulative risk of new albuminuria and composite endpoint events was higher for hypertension,diabetes,and overweight and obesity.Cox regression analysis suggested that hypertension,diabetes,and age were inde-pendent risk factors for albuminuria composite endpoint events.Further analysis found that patients with hypertension and/or diabetes had a higher risk of albu-minuria after being overweight/obese.After matching the propensity scores,the results showed that ACR,serum creatinine,and uric acid were higher in the over-weight and obese group than in the normal BMI group.Both new-onset albumi-nuria and albuminuria composite endpoint events were higher in the overweight and obese groups.Conclusion:1.Weight gain increases the risk of albuminuria and adversely affects renal function.2.In combination with diabetes and hypertension,the ef-fects of overweight or obesity on the occurrence of albuminuria is more obvious,and reasonable weight management strategies play an important role in control-ling the occurrence of chronic kidney disease.3.In this study,mild weight loss had no significant effect on the reversal of albuminuria,suggesting that the need for more aggressive weight management may contribute to renal protection in these individuals and may reduce or even reverse albuminuria.