Author: Stephen Thomas,

Chronic kidney disease (CKD) impacts over 37 million adults in the United States, with risk factors including diabetes, hypertension, atherosclerosis, and age, and shows notable racial disparities. CKD is linked to higher morbidity and mortality, often due to accelerated atherosclerotic vascular disease and acute coronary syndromes.

Obesity is now recognized as an independent risk factor for CKD, leading to obesity-related chronic kidney disease (ORCKD). ORCKD features altered renal hemodynamics, chronic inflammation, oxidative stress, and activation of the renin-angiotensin-aldosterone system (RAAS). Primary ORCKD, where obesity is the main cause, is marked by glomerulomegaly and focal segmental glomerulosclerosis. Contributing factors include lipotoxicity, adipocytokine dysregulation, and glomerular hypertension. Early detection of renal injury markers like proteinuria is crucial. Effective management includes weight loss, RAAS inhibitors, and emerging treatments such as CD-36 inhibitors and SGLT-2 inhibitors. Early intervention and comprehensive treatment can improve outcomes and reduce the burden of ORCKD.

Reference: Ali MM, Parveen S, Williams V, Dons R, Uwaifo GI. Cardiometabolic comorbidities and complications of obesity and chronic kidney disease (CKD). J Clin Transl Endocrinol. 2024;36:100341. doi: 10.1016/j.jcte.2024.100341.

A cross-sectional analysis involving 3,193 patients with chronic kidney disease (CKD) aimed to estimate adherence to CKD-specific dietary guidelines, identify factors associated with poor adherence, and examine the relationship between adherence and biomarkers. Dietary intake was assessed using a food frequency questionnaire, and a CKD diet score was developed based on intake of sodium, potassium, fiber, protein, sugar, and cholesterol.

Results showed that lower adherence to dietary recommendations was linked to younger age, higher body mass index, male gender, lower education, and certain lifestyle factors such as smoking, infrequent alcohol consumption, and low physical activity. Lower adherence was also associated with dyslipidemia, higher uric acid, and elevated C-reactive protein levels. These associations were mainly driven by low intake of fiber and potassium, and high intake of sugar and cholesterol. The study underscores the need for promoting CKD-specific dietary recommendations to improve health outcomes and reduce adverse prognoses in patients with CKD.

Reference: Kaesler N, Baid-Agrawal S, Grams S, et al. Low adherence to CKD-specific dietary recommendations associates with impaired kidney function, dyslipidemia, and inflammation. Eur J Clin Nutr. 2021;75(9):1389-1397. doi: 10.1038/s41430-020-00849-3.