WKD: Propaganda or Facts?!

Written by Meguid El Nahas on Wednesday, 08 March 2017. Posted in OLA Blog

WKD: Propaganda or Facts?!

The 2017 WKD theme is OBESITY & CKD implying a link between the incidence, progression and outcomes of CKD and Obesity. Presumably a harmful link...?!

Whilst I am aware of links between Obesity and the Metabolic syndrome, and between the Metabolic Syndrome and microalbuminuria...,

I am not fully aware of strong evidence to suggest that there is a:

1. Higher incidence of significant CKD = CKD3b in Obese individuals

2. Faster rate of CKD progression from CKD3 to 5 in Obese individuals

3. Increased CKD Mortality in Obese in individuals

4. Increased CKD Cardiovascular morbidity/mortality in Obese individuals

In fact, there is considerable evidence to the contrary,

that OBESITY IS PROTECTIVE IN CKD against morbidity and mortality...

https://www.ncbi.nlm.nih.gov/pubmed/27190330

So, I ask myself are WKD themes a form of propaganda...fake news...to convey a message based on weak, flawed or even inaccurate information...as long as the message is populist; Obesity is BAD...so it must be BAD for the kidneys....BAD for CKD patients...BAD all round...as expected in popular discourse...TOTALLY UN-EVIDENCE BASED!

A few years ago...the WKD Theme was DRINKING WATER WAS GOOD FOR THE KIDNEYS....another fallacy based on no evidence and playing into the populist myth that drinking a lot of water is good for your kidneys...?! TOTALLY UN-EVIDENCE BASED!

So...in the era of post truth and fake news and conviction by propaganda, the Nephrology world and profession is giving into that trend...the trend of Trump...Brexit...and other propaganda and fake news driven messages...that aim to convince, without evidence...and convey false messages...as long as they serve a purpose?!

So why is WKD and those behind this noble annual initiative chosing misleading themes...is it out of ignorance...that would be unforgivable for such highly placed leaders in the field...or is it to purposely mislead and play on people's established conviction to reinforce them...albeit by misinformation...to raise the profile of CKD...?!

I AM CONFUSED AND DISAPPOINTED...PROPAGANDA SEEM TO BE EVERYWHERE...FACST ARE LOST...MISLEADING FACTS AND NEWS DOMINATE...OUR WORLD, EVEN THAT OF NEPHROLOGY AND WKD!

 

Meguid El Nahas

Professor Meguid El Nahas PhD, FRCP

Chief Editor, OLA Director

Professor El Nahas was born in Cairo, Egypt and undertook his undergraduate medical education in...
Posted: 2 weeks 3 days ago by ctomson #21373
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Meguid, some evidence to support the claim that obesity may be associated with higher risks of progression comes from this rigorous analysis:

journals.plos.org/plosone/article?id=10....journal.pone.0173515
Posted: 2 weeks 3 days ago by elnahas #21374
elnahas's Avatar
Thank you Charlie,

Very interesting observational data suggesting an association between increasing BMI and incidence of advanced (stages 4-5) CKD.

For causality to be established, one would like to see that those whose weight comes down with time have a reversal in that trend...
Data from the OKINAWA study cohort shows the opposite; those who loose weight are at higher risk of developing CKD...
www.ncbi.nlm.nih.gov/pubmed/18836892

Very confusing literature as I suspect there are too many confounders to explain a simple causative association between obesity and incident CKD!
Posted: 2 weeks 3 days ago by arif.khwaja #21376
arif.khwaja's Avatar
Like you say they're likely to be many confounders here - in the Okinawa cohort weight loss may simply be a signal for general "unwellness"
Losing weight and cutting salt can have modest but real effects on BP and thereby reducing CV risk... anything that lowers BP will theoretically lower the risk of progression.. so from a public health perspective can't see the harm in telling people to lose weight... telling dialysis patients to lose weight is however a completely different matter an smart actually be harmful
Posted: 2 weeks 3 days ago by delanaye #21377
delanaye's Avatar
Pr El-Nahas,

We must know what we talk about...
All data (or most data) are epidemiological data. We must liv with poor evidence.
Do you "believe" or not in the concept of "hyperfiltration"? If yes, you cannot say that obesity is not harmful.
All the problem is the defintion of obesity, and still more the comparator used in the studies. To be provocative with an extreme example: I can believe that obesity is protective in comparison to a patient in dialysis with malnutrtion...but this comparison is simply unfair...What means BMI in dialysis patients? Is fat free mass not a more important concept? What about sarcopenia in dialysis patients? I also make the distinction (and the metaanalysis from NDT you does it as well) between dialysis and non-dialysis people...
Probably there is a part of propangada for WKD, but still, I still ask to my patient with severe obesity and severe CKD to try to loose some weight...
Posted: 2 weeks 3 days ago by elnahas #21378
elnahas's Avatar
There isnt a shred of evidence for the concept of "hyperfiltration" and its harm, except in 5/6th nephrectomised Munich Wistar rats.
Posted: 2 weeks 3 days ago by elnahas #21379
elnahas's Avatar
I object to FAKE NEWS...passed on as scientific facts by medical professionals!

A professional association between messages that want to be popularised....and FACTS!

Giving the public the impression that:

1. 20% of the population has CKD...and 30-50% of those over 65...IS FAKE NEWS!

2. WKD telling people that drinking water is good for your kidneys....IS FAKE NEWS!

3. WKD implying that Obesity causes CKD....IS FAKE NEWS!

4. Implying that CKD is a major healthcare problem...when <0.1% of the population has ESRD....IS FAKE NEWS!

A professional medical body and its annual celebration should not be aimed at FOOLING the public to achieve aims...not matter how noble they are...such as WEIGHT LOSS!
Posted: 2 weeks 3 days ago by arif.khwaja #21380
Posted: 2 weeks 3 days ago by elnahas #21381
elnahas's Avatar
Charlie,

When adjusted for age...BMI hardly a cause of advanced ESRD?!


[File Attachment: BMIandCKDUK.pdf]
Posted: 2 weeks 3 days ago by elnahas #21382
elnahas's Avatar
You mean the paper that showed that reduction in BP and improved glycemia control are good for renal outcomes in T2DM...?!

or

do you mean the paper where mGFR in hyperfiltering and hypofiltering and showed no impact on renal outcomes...
www.ncbi.nlm.nih.gov/pubmed/23447062
Posted: 2 weeks 3 days ago by elnahas #21383
elnahas's Avatar
In fact, reducing GFR by RAS inhibition, in other word reducing "hyperfiltration" may be harmful in the short and long term....as shown by Clase et al this month in KI; or at least meaningless in terms of long term protection:
www.ncbi.nlm.nih.gov/pubmed/?term=clase%2C+ace+inhibition

Then an editorial by Matt Weir, makes the perennial point, that may be valid, that if you look at progression from the lowest GFR point after starting RAS inhibition, those treated may have a better slope in the long run. This was also how AASK analysed its data for and against intensive BP control, initial drop in mGFR, but there was no difference in the long run. This is also what MDRD in 1994 claimed...that a LPD causes an acute GFR drop but then a better slope; even they could it make it count statistically!
Posted: 2 weeks 3 days ago by delanaye #21384
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Compared to previous key messages for WKD, this year message is not the worst...
I agree with point 1 and 2 (and maybe 4) on post #21379
CKD is yet a health problem because the cost of hemodialysis is so high ...not because this is a very prevalent disease (I think....)

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