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

Identifier:  imarina:9162435

Handle: https://hdl.handle.net/20.500.11797/imarina9162435

Authors:  Diaz-Lopez, Andres; Becerra-Tomas, Nerea; Ruiz, Veronica; Toledo, Estefania; Babio, Nancy; Corella, Dolores; Fito, Montse; Romaguera, Dora; Vioque, Jesus; Alonso-Gomez, Angel M; Warnberg, Julia; Martinez, J Alfredo; Serra-Majem, Luis; Estruch, Ramon; Tinahones, Francisco J; Lapetra, Jose; Pinto, Xavier; Tur, Josep A; Lopez-Miranda, Jose; Cano Ibanez, Naomi; Delgado-Rodriguez, Miguel; Matia-Martin, Pilar; Daimiel, Lidia; Antonio de Paz, Jose; Vidal, Josep; Vazquez, Clotilde; Ruiz-Canela, Miguel; Bullo, Monica; Sorli, Jose, V; Goday, Albert; Fiol, Miquel; Garcia-de-la-Hera, Manoli; Sierra, Lucas Tojal; Perez-Farinos, Napoleon; Zulet, Maria Angeles; Sanchez-Villegas, Almudena; Sacanella, Emilio; Carlos Fernandez-Garcia, Jose; Manuel Santos-Lozano, Jose; Gimenez-Gracia, Miquel; Bibiloni, Maria Del Mar; Diez-Espino, Javier; Ortega-Azorin, Carolina; Castaner, Olga; Morey, Marga; Torres-Collado, Laura; Sorto Sanchez, Carolina; Angel Munoz, Miguel; Ros, Emilio; Martinez-Gonzalez, Miguel A; Salas-Salvado, Jordi

Abstract:
Introduction: 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. Methods: Randomized controlled PREvencion con DIeta MEDiterranea-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 m(2)) and micro- to macroalbuminuria (UACR >= 30 mg/g), and reversion of moderately (45 to <60 mL/min/1.73 m(2)) to mildly impaired GFR (60 to <90 mL/min/1.73 m(2)) or micro- to macroalbuminuria. Results: After 1 year, eGFR declined by 0.66 and 1.25 mL/min/1.73 m(2) in the intervention and control groups, respectively (mean difference, 0.58 mL/min/1.73 m(2); 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. Conclusions: The PREDIMED-Plus lifestyle intervention approach may preserve renal function and delay CKD progression in overweight/obese adults.