However population based studies have demonstrated that obesity puts you at increased risk of requiring dialysis when compared to the non obese. The mechanism acting here is unlikely to be due to obesity related glomerulopathy and is largely unknown.
However there are theories that fat cells have the ability to produce hormones that act on the kidney such as leptin, adiponectin and tumour necrosis factor. These agents are known to cause inflammation in various tissues of the body. They have also been implicated as playing a role in other diseases of the kidney. The risk of severe renal disease is higher with each additional condition present in addition to being obese. So in the obese and hypertensive with diabetes and low levels of the good cholesterol(HDL), the highest risk of developing end stage renal disease occurs.
The risk can be reduced by treating each associated disease. So good blood pressure control to the lowest possible blood pressure that does not result in dizzyness when you stand suddenly, blood sugar that is well controlled, increasing good cholesterol (HDL) and lowering bad cholesterol (LDL.) are all indicated to improve outcomes.
In terms of weight loss, a reduction of risk occurs for every point reduction in BMI achieved. Therefore ANY weight loss, no matter how small the amount will be beneficial, with the biggest losers gaining the most.
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