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1. Obesity and the Kidney
Link and Evidence
Mohammed Abdel Gawad MD Neph, ESENeph
Lecturer of Nephrology, School of Medicine, NewGiza University
Nephrology Consultant, Alexandria
Founder of NephroTube.com
Chair of AFRAN Web/Media Committee
ISN Education SoMe Team Member
drgawad@gmail.com
@Gawad_Nephro
19, May, 2022

2. Obesity and the Kidney - Talk Outline
• Pathogenesis
• Pathology
• Clinical consequences
• Potential Interventions for the Management of Obesity
• Reverse Epidemiology of Obesity in Hemodialysis Patients (Obesity Paradox)

3. Obesity and the Kidney - Talk Outline
• Pathogenesis
• Pathology
• Clinical consequences
• Potential Interventions for the Management of Obesity
• Reverse Epidemiology of Obesity in Hemodialysis Patients (Obesity Paradox)

4. Front Med (Lausanne). 2021 Apr 13;8:655871.

5. Nat Rev Nephrol. 2017 Mar;13(3):181-190.

6. Nat Rev Nephrol. 2017 Mar;13(3):181-190.

7. Nutrients 2022, 14, 3937.

8. Front Med (Lausanne). 2023 Feb 28;10:1134644

9. Nat Rev Nephrol. 2017 Mar;13(3):181-190.

10. Nat Rev Nephrol. 2017 Mar;13(3):181-190.

11. Obesity and the Kidney - Talk Outline
• Pathogenesis
• Pathology
• Clinical consequences
• Potential Interventions for the Management of Obesity
• Reverse Epidemiology of Obesity in Hemodialysis Patients (Obesity Paradox)

12. Obesity and the Kidney - Talk Outline
• Pathogenesis
• Pathology
• Clinical consequences
• Potential Interventions for the Management of Obesity
• Reverse Epidemiology of Obesity in Hemodialysis Patients (Obesity Paradox)

13. Indian J Nephrol. 2017 Mar-Apr; 27(2): 85–92

14. Kidney Int. 2019 Mar;95(3):647-654

15. Obesity and the Kidney - Talk Outline
• Pathogenesis
• Pathology
• Clinical consequences
• Potential Interventions for the Management of Obesity
• Reverse Epidemiology of Obesity in Hemodialysis Patients (Obesity Paradox)

16. Obesity and the Kidney - Talk Outline
• Pathogenesis
• Pathology
• Clinical consequences
• Potential Interventions for the Management of Obesity
• Reverse Epidemiology of Obesity in Hemodialysis Patients (Obesity Paradox)

17. Nutrients. 2021 Dec; 13(12): 4482.

18. Nutrients. 2021 Dec; 13(12): 4482.

19. Rev Urol. 2020; 22(1): 17–23.

20. Minerva Urol Nefrol. 2018 Aug;70(4):393-400.

21. Minerva Urol Nefrol. 2018 Aug;70(4):393-400.

22. Int J Mol Sci. 2019 Nov; 20(22): 5683.

23. Obesity and the Kidney - Talk Outline
• Pathogenesis
• Pathology
• Clinical consequences
• Potential Interventions for the Management of Obesity
• Reverse Epidemiology of Obesity in Hemodialysis Patients (Obesity Paradox)

24. Obesity and the Kidney - Talk Outline
• Pathogenesis
• Pathology
• Clinical consequences
• Potential Interventions for the Management of Obesity
• Reverse Epidemiology of Obesity in Hemodialysis Patients (Obesity Paradox)

25. Front Med (Lausanne). 2023 Feb 28;10:1134644

26. Bariatric Surgery
Nature Reviews Nephrology volume 16, pages709–720 (2020)

27. Bariatric Surgery
Nature Reviews Nephrology volume 16, pages709–720 (2020)

28. Bariatric Surgery
Nature Reviews Nephrology volume 16, pages709–720 (2020)

29. Bariatric Surgery
Nature Reviews Nephrology volume 16, pages709–720 (2020)

30. Nature Reviews Nephrology volume 16, pages709–720 (2020)

31. Front Med (Lausanne). 2023 Feb 28;10:1134644

32. Obesity and the Kidney - Talk Outline
• Pathogenesis
• Pathology
• Clinical consequences
• Potential Interventions for the Management of Obesity
• Reverse Epidemiology of Obesity in Hemodialysis Patients (Obesity Paradox)

33. Obesity and the Kidney - Talk Outline
• Pathogenesis
• Pathology
• Clinical consequences
• Potential Interventions for the Management of Obesity
• Reverse Epidemiology of Obesity in Hemodialysis Patients (Obesity Paradox)

34. What is meant by Reverse Epidemiology ?
• While obesity, hypertension and hypercholesterolemia (and other
parameters) are well-established indicators of poor cardiovascular
health and death in general population,
• Reverse epidemiology holds that these states actually increase the
chance of survival in many people including dialysis patients.

35. HD Patients vs. General Population
BMI Associated Death Risk
Kalantar-Zadeh: Reverse epidemiology. Journal of Renal Nutrition, Vol 15, No 1
(January), 2005: pp 142-147

36. Reverse Epidemiology of CV Risk factors
It is not only OBESITY & BMI !!
Kamyar Kalantar-Zadeh, Denis Fouque, and Joel D. Kopple. Journal of Renal Nutrition, Vol 14, No 2
(April), 2004: pp 64-71

37. Possible Explanations for Reverse
Epidemiology of BMI
• 1- Hemodynamic State in Obese Individuals
• 2- Tumor Necrosis Factor-Receptors
• 3- Neurohormonal Alterations
• 4- Survival Bias & Time Discrepancies Between Competitive
Risk Factors: Overnutrition Versus Undernutrition
• 5- Malnutrition–Inflammation Complex Syndrome
• 6- Endotoxin – Lipoprotein Hypothesis

38. Kalantar-Zadeh et al. Am J Epidemiol. 2012;175(8):793–803

39. Kalantar-Zadeh et al. Am J Epidemiol. 2012;175(8):793–803
So, it’s the muscle
mass not the body
fat

40. Kalantar-Zadeh et al. Am J Epidemiol. 2012;175(8):793–803
• The protective effect conferred by high BMI is limited to those patients
with normal or high muscle mass.
• High BMI patients with inferred high body fat have increased and not
decreased mortality.

41. Home Messages
• Obesity related to increased kidney stress and injury
• Kidney injury may occur to other pathologies in obese people
• Obesity affect the kidney by multiple clinical consequences
• Multiple interventions are available to interfere the obesity effect on
kidney
• High muscular mass associated with better survival in HD patients

42. Thank You
drgawad@gmail.com
twitter: @Gawad_Nephro
Facebook: Doctor.Gawad
www.NephroTube.com