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Randomized Controlled Trial
. 2021;52(1):45-58.
doi: 10.1159/000513664. Epub 2021 Feb 8.

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

Andrés Díaz-López  1   2   3   4 , Nerea Becerra-Tomás  1   2   3   4 , Verónica Ruiz  1   2   3 , Estefania Toledo  4   5 , Nancy Babio  1   2   3   4 , Dolores Corella  4   6 , Montse Fitó  4   7 , Dora Romaguera  4   8 , Jesús Vioque  9   10 , Ángel M Alonso-Gómez  4   11 , Julia Wärnberg  4   12 , J Alfredo Martínez  4   13   14 , Luís Serra-Majem  4   15 , Ramon Estruch  4   16 , Francisco J Tinahones  4   17 , José Lapetra  4   18 , Xavier Pintó  4   19 , Josep A Tur  4   8   20 , José López-Miranda  4   21 , Naomi Cano Ibañez  10   22 , Miguel Delgado-Rodríguez  10   23 , Pilar Matía-Martín  4   24 , Lidia Daimiel  14 , Jose Antonio de Paz  10   25 , Josep Vidal  26   27 , Clotilde Vázquez  4   28 , Miguel Ruiz-Canela  4   5 , Mònica Bulló  1   2   3   4 , José V Sorlí  4   6 , Albert Goday  4   7 , Miquel Fiol  4   8 , Manoli García-de-la-Hera  9   10 , Lucas Tojal Sierra  4   11 , Napoleón Pérez-Farinós  4   29 , Maria Ángeles Zulet  4   13 , Almudena Sánchez-Villegas  4   15 , Emilio Sacanella  4   16 , José Carlos Fernández-García  4   17 , José Manuel Santos-Lozano  4   18 , Miquel Gimenez-Gracia  4   19 , Maria Del Mar Bibiloni  4   8   20 , Javier Diez-Espino  4   5 , Carolina Ortega-Azorin  4   6 , Olga Castañer  4   7 , Marga Morey  4   8 , Laura Torres-Collado  9   10 , Carolina Sorto Sanchez  4   11 , Miguel Ángel Muñoz  4   7 , Emilio Ros  4   30 , Miguel A Martinez-Gonzalez  4   5   31 , Jordi Salas-Salvadó  32   33   34   35 ; PREDIMED-Plus Investigators
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Free article
Randomized Controlled Trial

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

Andrés Díaz-López et al. Am J Nephrol. 2021.
Free article

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 "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 m2) and micro- to macroalbuminuria (UACR ≥30 mg/g), and reversion of moderately (45 to <60 mL/min/1.73 m2) to mildly impaired GFR (60 to <90 mL/min/1.73 m2) or micro- to macroalbuminuria.

Results: After 1 year, eGFR declined by 0.66 and 1.25 mL/min/1.73 m2 in the intervention and control groups, respectively (mean difference, 0.58 mL/min/1.73 m2; 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.

Keywords: Dietary intervention; Glomerular filtration rate; Kidney function; Mediterranean diet; PREDIMED-Plus; Weight loss.

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