Obesity is strongly associated with the development of diabetes mellitus and chronic kidney disease (CKD), but there is evidence for a bidirectional relationship wherein the kidney also acts as a key regulator of body weight. In this Review, we highlight the mechanisms implicated in obesity-related CKD, and outline how the kidney might modulate feeding and body weight through a growth differentiation factor 15-dependent kidney–brain axis. The favourable effects of bariatric surgery on kidney function are discussed, and medical therapies designed for the treatment of diabetes mellitus that lower body weight and preserve kidney function independent of glycaemic lowering, including sodium–glucose cotransporter 2 inhibitors, incretin-based therapies and metformin, are also reviewed. In summary, we propose that kidney function and body weight are related in a bidirectional fashion, and that this interrelationship affects human health and disease.

肥胖与糖尿病和慢性肾病 (CKD) 的发展密切相关，但有证据表明存在双向关系，其中肾脏也充当体重的关键调节者。在这篇综述中，我们重点介绍了与肥胖相关的 CKD 相关的机制，并概述了肾脏如何通过生长分化因子 15 依赖的肾脑轴来调节进食和体重。讨论了减肥手术对肾功能的有利影响，以及专为治疗糖尿病而设计的药物疗法，这些疗法可以降低体重并保持肾功能，不受血糖降低的影响，包括钠-葡萄糖协同转运蛋白 2 抑制剂、基于肠促胰岛素的疗法和二甲双胍，也受到审查。总之，我们认为肾功能和体重以双向方式相关，并且这种相互关系影响人类健康和疾病。