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Effect of an intensive weight-loss lifestyle intervention on kidney function: a randomized controlled trial

Autores: Diaz-Lopez, A.; Becerra-Tomas, N.; Ruiz, V.; Toledo Atucha, Estefanía; Babio, N.; Corella, D.; Fito, M.; Romaguera, D.; Vioque, J.; Alonso-Gomez, A. M.; Warnberg, J.; Martínez Hernández, Alfredo; Serra-Majem, L; Estruch, R.; Tinahones, F. J.; Lapetra, J.; Pinto, X.; Tur, J. A.; Lopez-Miranda, J.; Cano-Ibanez, N.; Delgado-Rodriguez, M.; Matia-Martin, P.; Daimiel, L.; de Paz, J. A. ; Vidal, J.; Vazquez, C.; Ruiz-Canela, Miguel; Bullo, M.; Sorli, J. V.; Goday, A.; Fiol, M.; Garcia de la Hera, M.; Tojal-Sierra, L.; Perez-Farinos, N.; Zulet Alzórriz, María de los Ángeles; Sanchez-Villegas, A.; Sacanella, E.; Fernandez-Garcia, J. C.; Santos-Lozano, J. M.; Gimenez-Gracia, M.; Bibiloni, M. D. M. ; Diez Espino, Javier; Ortega-Azorin, C.; Castaner, O.; Morey, M.; Torres-Collado, L.; Sorto-Sanchez, C.; Munoz, M. A.; Ros, E.; Martínez González, Miguel Ángel
ISSN: 0250-8095
Volumen: 52
Número: 1
Páginas: 45 - 58
Fecha de publicación: 2021
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.