Two sides of the same coin: role of insufficient and excessive weight in patogenesis of the chronic kidney disease

In recent years, a global increase in the incidence of Chronic Kidney Disease (CKD) has been observed. This problem has both medical (high mortality from cardiovascular causes in this population) and economic (large costs of the health care system for a relatively small category of patients) character. Therefore, a search for solutions for reduction of the CKD burden is an important problem of modern nephrology. Nutritional status impairments are widespread. They are predictors of adverse outcomes in CKD. However, with early detection they can be relatively easily corrected with special diet. Variations of nutritional status impairments include both underweight and overweight. The impact of nutritional status disorders on the progression and clinical outcomes of CKD varies depending on the stage: protein-energy wasting (PEW) is an unfavorable factor and can be found in all stages of CKD. It is more common at the later stages, whereas, obesity plays a greater role in CKD progression on its early stages. However, in dialysis patients, obesity is associated with better survival (reverse epidemiology). The combination of PEW and obesity (sarcopenia-obesity complex), was found in all stages of CKD. It was suggested that in patient with normal weight or overweight, it is the loss of muscle mass and the uneven distribution of adipose tissue by the central type, adversely affect the prognosis. The nutritional status disorders are amenable to correction and their timely identification, modification of lifestyle, correction of dietary regime and ratio can ease the burden of CKD in the group of high-risk patients. However, in practice, the importance of determining and correcting nutritional status impairments is often underestimated. The purpose of this review was to identify the role of overweight and underweight in the pathogenesis and progression of CKD, to discuss the results of the recent studies on this topic and to improve understanding of the mechanisms of violation of nutritional status in CKD, which will undoubtedly contribute to the development of effective strategies for their prevention, diagnosis and treatment.

хроническая болезнь почек, диализ, нутриционный статус, ожирение, белково-энергетическая недостаточность, метаболический синдром, chronic kidney disease, dialysis, nutritional status, obesity, protein energy wasting, metabolic syndrome

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