| Summary: | Observational studies suggest there is an independent relationship between obesity and chronic kidney disease (CKD). The mechanisms of this relationship remain unclear, although contributing factors include inflammation, insulin resistance, and hypertension. The aim of this thesis was to investigate the relationship between obesity and CKD using a range of study methodologies, deploying established and novel weight loss interventions. Participation in a structured multidisciplinary weight loss intervention may be associated with a longer event-free period for the combined outcome of all cause mortality and cardiovascular morbidity in obese patients with CKD, compared to those referred to, but not participating in the intervention. Estimated kidney function significantly underpredicted measured glomerular filtration rate in obese patients with stages 3-4 CKD. Laparoscopic sleeve gastrectomy weight loss surgery was effective for weight loss in obese patients with CKD, although, in the small samples studied in this thesis, the risk for complications and adverse events, including mortality, may be greater in patients undergoing haemodialysis than in obese patients with earlier stages of CKD. Sleeve gastrectomy resulted in significantly greater weight loss than best medical care in obese patients with CKD, and may improve kidney function by reducing hyperfiltration. Quality of life, adiponectin and insulin resistance improved following sleeve gastrectomy, compared to best medical care in obese patients with moderate CKD. The odds ratio for CKD increases with overweight and obesity in the Health Survey for England 2010, compared to healthy weight participants. Evidence of a relationship between obesity and risk of CKD in a national sample of the United Kingdom population confirms the perceived need for safe and effective weight loss interventions for obese patients with CKD in a national context.
|
|---|
