Are we ready for an adipocentric approach in people living with type 2 diabetes and chronic kidney disease?
Oscar Moreno-PerezRebeca Reyes-GarciaInés Modrego-PardoMarina López-MartínezMaria José SolerPublished in: Clinical kidney journal (2024)
We are entering a new era in the management of adiposity-based chronic disease (ABCD) with type 2 diabetes (T2D) and related chronic kidney disease (CKD). ABCD, T2D and CKD can affect almost every major organ system and have a particularly strong impact on the incidence of cardiovascular disease (CVD) and heart failure. ABCD and the associated insulin resistance are at the root of many cardiovascular, renal and metabolic (CKM) disorders, thus an integrated therapeutic framework using weight loss (WL) as a disease-modifying intervention could simplify the therapeutic approach at different stages across the lifespan. The breakthrough of highly effective WL drugs makes achieving a WL of >10% possible, which is required for a potential T2D disease remission as well as for prevention of microvascular disease, CKD, CVD events and overall mortality. The aim of this review is to discuss the link between adiposity and CKM conditions as well as placing weight management at the centre of the holistic CKM syndrome approach with a focus on CKD. We propose the clinical translation of the available evidence into a transformative Dysfunctional Adipose Tissue Approach (DATA) for people living with ABCD, T2D and CKD. This model is based on the interplay of four essential elements (i.e. adipocentric approach and target organ protection, dysfunctional adiposity, glucose homeostasis, and lifestyle intervention and de-prescription) together with a multidisciplinary person-centred care. DATA could facilitate decision-making for all clinicians involved in the management of these individuals, and if we do this in a multidisciplinary way, we are prepared to meet the adipocentric challenge.
Keyphrases
- chronic kidney disease
- insulin resistance
- end stage renal disease
- adipose tissue
- weight loss
- cardiovascular disease
- heart failure
- metabolic syndrome
- randomized controlled trial
- high fat diet
- type diabetes
- decision making
- palliative care
- bariatric surgery
- weight gain
- quality improvement
- healthcare
- physical activity
- risk factors
- electronic health record
- cardiovascular events
- left ventricular
- peritoneal dialysis
- roux en y gastric bypass
- big data
- deep learning
- atrial fibrillation
- glycemic control
- blood glucose
- systemic lupus erythematosus
- coronary artery disease
- climate change
- disease activity