Maintaining a healthy weight is a cornerstone of overall well-being, and it plays a particularly crucial role in kidney health. Excess weight places additional strain on the kidneys, potentially leading to or exacerbating kidney disease. This article explores the intricate relationship between weight loss and kidney function, offering practical steps and insights for protecting your kidneys while achieving a healthier weight.
The Connection Between Weight and Kidney Health
Carrying extra weight forces the kidneys to work harder. It also elevates the risk of developing diabetes and high blood pressure, the two leading causes of kidney disease. Obesity can directly affect the kidneys by crowding and compressing them. The kidneys must also work harder to maintain a larger body. Inflammation, insulin resistance, and blood pressure-raising hormones are more prevalent in obese people.
Obesity is associated with the progression of kidney disease. Microalbuminuria, an early marker of chronic kidney disease (CKD) and a predictor of end-stage kidney disease, has been linked to obesity. The severity of obesity is directly proportional to the magnitude of microalbuminuria.
The good news is that even modest weight loss can yield significant benefits. Losing just 5-10% of your body weight can substantially lower the risk of developing diabetes, high blood pressure, and high cholesterol, all of which contribute to kidney problems.
Understanding Your Body Composition
Body Mass Index (BMI) is a tool used to estimate body fat based on height and weight. While it serves as a good screening tool, it's not specific to the individual. The BMI categories are:
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- Underweight: Less than 18.5
- Average weight: 18.5-24.9
- Overweight: 25-29.9
- Obesity: BMI of 30 or greater
However, BMI has limitations. As renal dietitian Golnaz Ghomeshi Friedman points out, "BMI doesn't tell us how weight is distributed." Paying attention to fat accumulation in the midsection can be helpful. Waist size indicates a higher risk of chronic diseases, including CKD.
Practical Steps to Lose Weight and Protect Kidney Health
Here are actionable steps you can take to lose weight and promote kidney health:
1. Embrace a Varied and Healthy Diet
A healthy diet is essential for achieving and maintaining a healthy weight. Start by focusing on the types of foods you consume. Limit saturated and trans fats, excess salt, and added sugars. Prioritize nutritious foods like fiber, lean proteins, and monounsaturated or polyunsaturated fats. Fat is an essential part of one's diet, so don't eliminate it completely.
Learn how to make healthier food choices and learn what a good portion size is. Your doctor or a registered dietitian can help you understand these. Eat fewer foods that are high in fats (fast food, butter, oil, lard, etc.) and sugar. Eat more “whole wheat” carbohydrates rather than “white” carbohydrates (white breads, bagels, white pasta, white rice, etc.). Eat a wide variety of foods that are not processed. Choose fruits and vegetables, lean meats and fish, whole grains and low-fat dairy products. Learn how to read nutrition labels when you shop for foods. Look for high levels of fiber and low levels of fat, sugar, and carbohydrate.
2. Incorporate Regular Exercise
Aim for at least 150 minutes of moderate exercise each week. Most adults should also engage in muscle-strengthening activities at least two days a week. Avoid pushing yourself too hard, as injuries can hinder long-term weight loss. Gradual progression is key. Increase your physical activity.
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3. Monitor Your Kidney Health
Early detection of kidney disease is crucial for effective management and protection of kidney function. Ask your healthcare professional for these two simple tests:
- Urine test: The urine albumin-creatinine ratio (uACR) test measures albumin (a protein) and creatinine (a waste product) levels in your urine. Healthy kidneys retain albumin in the blood and filter out creatinine in the urine.
- Blood test: The estimated glomerular filtration rate (eGFR) checks the blood for creatinine. The kidneys typically remove this waste product.
Even before any symptoms appear, routine blood work can indicate that you might be in the early stages of chronic kidney disease. And the earlier it's detected, the easier it is to treat. This is why regular checkups with your doctor are important. If your doctor suspects the onset of chronic kidney disease, they may schedule a variety of other tests. They may also refer you to a kidney specialist, a nephrologist like myself. Urine tests can reveal abnormalities and give clues to the underlying cause of the chronic kidney disease. And this can also help to determine the underlying issues. Various imaging tests like ultrasounds or CT scans can be done to help your doctor assess the size, the structure, as well as evaluate the visible damage, inflammation or stones of your kidneys. And in some cases, a kidney biopsy may be necessary.
4. Manage Blood Sugar and Blood Pressure
Diabetes and high blood pressure are major contributors to kidney disease. Both can damage the blood vessels in the kidneys, impairing their ability to filter waste effectively.
- Diabetes: Work closely with your healthcare team to maintain blood sugar levels within your target range. This may involve regular monitoring, medication, and lifestyle changes, including diet and exercise.
- High Blood Pressure: High blood pressure places excessive strain on your kidneys. If your blood pressure is above your target range, consult a healthcare provider about strategies to lower it. They may recommend reducing sodium intake, exercising regularly, managing stress, and taking medication.
5. Consider the Impact of Weight Loss on CKD
Clinically significant weight change is common in moderate to severe chronic kidney disease but has no relationship to baseline kidney function.
Patients with moderate/severe CKD experience significant weight‐change, but this has no relationship to baseline kidney function. 1. There is limited information published on the usual pattern of weight change in those with moderate to severe kidney disease and elevated BMI. Annualized weight changes are highly dependent on the follow‐up time, as small changes over a short period of time become relatively large changes if extrapolated over a year. In addition, clinicians do not know ahead of time when or whether their patients will start dialysis. This makes it difficult to use much of the published data for risk assessment in CKD until after dialysis has commenced.
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The Role of Diet in Kidney Health and Weight Loss
Recent research indicates that weight control can preserve kidney function and improve heart health. Losing even a small amount of weight, such as 10 pounds, can help manage high blood pressure and reduce the risk of diabetes and heart disease. In cases of severe obesity, weight loss surgery may be recommended.
Dietary Strategies and Kidney Function: Insights from the DIRECT Trial
The 2-year Dietary Intervention Randomized Controlled Trial (DIRECT) investigated the effects of different weight loss diets on renal function. The study involved 318 participants with moderate obesity, with or without type 2 diabetes. Participants were randomized to low-fat, Mediterranean, or low-carbohydrate diets.
The results showed that all three diets led to significant improvements in eGFR, a measure of kidney function. The low-carbohydrate diet was as safe as the Mediterranean or low-fat diets in preserving or improving renal function. Improvements in eGFR were observed regardless of whether participants had type 2 diabetes or lower baseline renal function.
A decrease in fasting insulin and systolic blood pressure were independently associated with increased eGFR. The study suggests that weight loss-induced improvements in blood pressure and insulin sensitivity may mediate the positive effects of these diets on kidney function.
The Importance of Managing Chronic Kidney Disease (CKD)
Chronic kidney disease (CKD), also known as chronic kidney failure, involves a gradual loss of kidney function. In the early stages, there might be few signs or symptoms. Treatment focuses on slowing the progression of kidney damage, typically by addressing the underlying cause.
Understanding the Kidneys and Their Function
The kidneys play many important roles keeping our bodies in balance. They remove waste and toxins, excess water from the bloodstream, which is carried out of the body in urine.
Causes and Risk Factors for CKD
There are quite a few things that can cause or put you at higher risk for chronic kidney disease. Some of them are not things that can be avoided. Your risk is simply higher if you have a family history of certain genetic conditions like polycystic kidney disease or some autoimmune diseases like lupus or IgA nephropathy. Defects in the kidney structure can also cause your kidneys to fail, and you have an increased risk as you get older. Sometimes, other common medical conditions can increase your risk. Diabetes is the most common cause of kidney disease. Both type 1 and type 2 diabetes. But also heart disease and obesity can contribute to the damage that causes kidneys to fail. Urinary tract issues and inflammation in different parts of the kidney can also lead to long-term functional decline. There are things that are more under our control: Heavy or long-term use of certain medications, even those that are common over-the-counter.
Symptoms of CKD
Often there are no outward signs in the earlier stages of chronic kidney disease, which is grouped into stages 1 through 5. Generally, earlier stages are known as 1 to 3. And as kidney disease progresses, you may notice the following symptoms. Nausea and vomiting, muscle cramps, loss of appetite, swelling via feet and ankles, dry, itchy skin, shortness of breath, trouble sleeping, urinating either too much or too little. However, these are usually in the later stages, but they can also happen in other disorders. So don't automatically interpret this as having kidney disease.
Treatment Options for CKD
Treatment is determined by what is causing your kidneys to not function normally. Treating the cause is key, leading to reduced complications and slowing progression of kidney disease. For example, getting better blood pressure control, improved sugar control and diabetes, and reducing weight are often key interventions. However, existing damage is not usually reversible. In some conditions, treatment can reverse the cause of the disease. So seeking medical review is really important. Individual complications vary, but treatment might include high blood pressure medication, diuretics to reduce fluid and swelling, supplements to relieve anemia, statins to lower cholesterol, or medications to protect your bones and prevent blood vessel calcification. A lower-protein diet may also be recommended. It reduces the amount of waste your kidneys need to filter from your blood. These can not only slow the damage of kidney disease, but make you feel better as well. When the damage has progressed to the point that 85 to 90 percent of your kidney function is gone, and they no longer work well enough to keep you alive, it's called end-stage kidney failure. But there are still options. There's dialysis, which uses a machine to filter the toxins and remove water from your body as your kidneys are no longer able to do this. Where possible, the preferred therapy is a kidney transplant.
Lifestyle Modifications for Managing CKD
If you have kidney disease, there are lifestyle choices. Namely quit smoking. Consuming alcohol in moderation. If you're overweight or obese, then try to lose weight. Staying active and getting exercise can help not only with your weight, but fatigue and stress. If your condition allows, keep up with your routine, whether that's working, hobbies, social activities, or other things you enjoy. It can be helpful to talk to someone you trust, a friend or relative who's good at listening. Or your doctor could also refer you to a therapist or social worker. It can also be helpful to find a support group and connect with people going through the same thing.
End-Stage Kidney Disease (ESKD)
End-stage kidney disease (ESKD) is the last stage of long-term (chronic) kidney disease. ESRD occurs when the kidneys are no longer able to work at a level needed for day-to-day life. The most common causes of ESRD in the United States are diabetes and high blood pressure. These conditions can damage your kidneys.
ESRD almost always comes after chronic kidney disease.
Treatment Options for ESKD
ESRD may need to be treated with dialysis or kidney transplant. You may need to stay on a special diet or take medicines to help your body work well.
- Dialysis: Dialysis does some of the job of the kidneys when they stop working well. Usually, you will go on dialysis when you have only 10% to 15% of your kidney function left. Even people who are waiting for a kidney transplant may need dialysis while waiting.
- Kidney Transplant: A kidney transplant is surgery to place a healthy kidney into a person with kidney failure. Your provider will refer you to a transplant center. There, you will be seen and evaluated by the transplant team. They will want to make sure that you are a good candidate for kidney transplant.
- Special Diet: You may need to continue following a special diet for chronic kidney disease. The diet may include: Eating foods low in protein to limit your total daily protein intake Getting enough calories if you are losing weight Limiting fluids Limiting salt, potassium, phosphorous, and other electrolytes
- Other Treatment: Other treatment depends on your symptoms, but may include: Extra calcium and vitamin D. (Always talk to your provider before taking supplements.) Medicines called phosphate binders, to help prevent blood phosphorous levels from becoming too high. Treatment for anemia, such as extra iron in the diet, iron pills or shots, shots of a medicine called erythropoietin, and blood transfusions. Medicines to control your blood pressure.
Outlook for ESKD
End-stage kidney disease leads to death if you do not have dialysis or a kidney transplant. Both of these treatments have risks.
Cautions and Considerations
It's important to note that weight loss in CKD has been associated with higher mortality. Consequently, blanket weight loss recommendations in this population are controversial.
Weight Change in CKD
Patients with moderate to severe CKD experience significant weight changes, but this has no relationship to baseline kidney function.
This study was performed in an unselected group of 310 patients with moderate to severe non‐dialysis CKD and overweight or obesity. A significant proportion experienced clinically significant weight changes, but because these changes were balanced, the mean weight for the group fell only modestly during follow‐up. There was no association between baseline severity of CKD and subsequent weight change.