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Effect of an Intensive Weight-Loss Lifestyle Intervention on Kidney Function: A Randomized Controlled Trial
Author(s) -
Andrés DíazLópez,
Nerea BecerraTomás,
Verónica Ruiz,
Estefanía Toledo,
Nancy Babió,
Dolores Corella,
Montse Fitó,
Dora Romaguera,
Jesús Vioque,
Ángel M. AlonsoGómez,
Julia Wärnberǵ,
J. Alfredo Martínéz,
Luís Serra-Majem,
Ramón Estruch,
Francisco J. Tinahones,
José Lapetra,
Xavier Pintó,
Josep A. Tur,
José LópezMiranda,
Naomi Cano Ibáñez,
Miguel DelgadoRodríguez,
Pilar MatíaMartín,
Lidia Daimiel,
José Antonio de Paz,
Josep Vidal,
Clotilde Vázquez,
Miguel Ruíz-Canela,
Mònica Bulló,
José V. Sorlí,
Albert Goday,
Miquel Fiol,
Manoli García-de-la-Hera,
Lucas Tojal-Sierra,
Napoleón PérezFarinós,
M. Ángeles Zulet,
Almudena SánchezVillegas,
Emilio Sacanella,
José Carlos Fernández-García,
José Manuel SantosLozano,
Miquel Gimenez-Gracia,
Javier DíezEspino,
Carolina OrtegaAzorín,
Olga Castañer,
Marga Morey,
Laura TorresCollado,
Carolina Sorto Sanchez,
Miguel A. Muñoz,
Emilio Ros,
Jordi SalasSalvadó,
PREDIMED-Plus Investigators
Publication year - 2021
Publication title -
american journal of nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.394
H-Index - 85
eISSN - 1421-9670
pISSN - 0250-8095
DOI - 10.1159/000513664
Subject(s) - medicine , renal function , randomized controlled trial , overweight , weight loss , creatinine , incidence (geometry) , obesity , physics , optics
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 “PREvención con DIeta MEDiterránea-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.