Renal complications in eating disorders with metabolic risk factors: a systematic review
DOI:
https://doi.org/10.15343/0104-7809.202650e18072025IKeywords:
Bulimia Nervosa, Renal Disorders, Obese Patients, Electrolytes, Renal FailureAbstract
Bulimia nervosa can have serious physiological and psychological effects in obese patients. Electrolyte disturbances, dehydration, and metabolic burden caused by bulimia nervosa can cause kidney injury. Furthermore, obesity, as an independent risk factor for kidney disease, may exacerbate renal complications in this population. The aim of the present systematic review was to evaluate renal disorders in patients with bulimia nervosa, with particular focus on obese individuals. A total of ten studies (including case reports and observational studies) published between 2001 and 2024 in PubMed, Scopus, Web of Science, and Cochrane Library were included. The results suggest that the most common pathway of renal injury in bulimia nervosa is chronic hypokalemia and dehydration, which may lead to hypokalemic nephropathy, tubulointerstitial nephritis, and acute or chronic kidney injury. Electrolyte and acid-base disturbances, along with decreased renal function, are frequent, and the risk of chronic kidney disease may be higher in obese patients. Limitations of the available evidence include the predominance of case reports and small observational studies, which restrict generalizability and preclude definitive causal conclusions. These findings highlight the need for cautious clinical monitoring, early renal assessment, and consideration of obesity as a compounding factor in managing patients with bulimia nervosa.
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Jiang Z, Wang Y, Zhao X, Cui H, Han M, Ren X, Gang X, Wang G. Obesity and chronic kidney disease. American Journal of Physiology Endocrinology and Metabolism. 2023 Jan 5. DOI: 10.1152/ajpendo.00179.2022
Gómez-Ambrosi J, Catalán V, Frühbeck G. The evolution of the understanding of obesity over the last 100 years. International Journal of Obesity. 2025;49(2):168-76. DOI: 10.1038/s41366-024-01668-3
Mohajan D, Mohajan HK. Bulimia Nervosa: A Psychiatric Problem of Disorder. Innovation in Science and Technology. 2023 May 9;2(3):26-32.
Baenas I, Etxandi M, Fernández-Aranda F. Medical complications in anorexia and bulimia nervosa. Medicina Clínica (English Edition). 2024 Jan 26;162(2):67-72. DOI: 10.1016/j.medcli.2023.07.028
Puckett L. Renal and electrolyte complications in eating disorders: a comprehensive review. Journal of eating disorders. 2023;11(1):26. DOI: 10.1186/s40337-023-00751-w
Gurevich E, Steiling S, Landau D. Incidence of impaired kidney function among adolescent patients hospitalized with anorexia nervosa. JAMA network open. 2021;4(11):e2134908-e. DOI: 10.1001/jamanetworkopen.2021.34908.
Kotsis V, Martinez F, Trakatelli C, Redon J. Impact of obesity in kidney diseases. Nutrients. 2021;13(12):4482. DOI: 10.3390/nu13124482.
Jiang Z, Wang Y, Zhao X, Cui H, Han M, Ren X, et al. Obesity and chronic kidney disease. American Journal of Physiology-Endocrinology and Metabolism. 2023. DOI: 10.1152/ajpendo.00179.2022.
Jebai R, Gbadamosi SO, Nassar Gorra L, Madhivanan P. Comment on: Non-Cholesterol Sterol Concentrations as Biomarkers for Cholesterol Absorption and Synthesis in Different Metabolic Disorders: A Systematic Review. Nutrients. 2019;11(4):780. DOI: 10.3390/nu11040780.
Miyahara H, Shigeyasu Y, Fujii C, Tanaka C, Hanzawa M, Sugihara A, et al. Assessment of the renal function of patients with anorexia nervosa. BioPsychoSocial medicine. 2024;18(1):19. DOI: 10.1186/s13030-024-00316-6.
Li Cavoli G, Mulè G, Rotolo U. Renal involvement in psychological eating disorders. Nephron Clinical Practice. 2011;119(4):c338-c41. DOI: 10.1159/000333798
Khatri V, Bauschka M, Foley M, Lundberg C, Mehler P. A Multi-Disciplinary Approach to Managing End-Stage Renal Disease in Anorexia Nervosa: A Case Report. Clinical Medicine Insights: Case Reports. 2023;16:11795476231169385. DOI: 10.1177/11795476231169385
Stheneur C, Blanchet C, Mattar L, Dicembre M, Wilson K, Berthoz S, et al. Determinants and risk factors for renal damage: where do patients hospitalized for severe anorexia nervosa stand? A multi-center study. Journal of Eating Disorders. 2024;12(1):72. DOI: 10.1186/s40337-024 01024-w
Yasuhara D, Naruo T, Taguchi S, Umekita Y, Yoshida H, Nozoe Si. “End‐stage kidney” in longstanding bulimia nervosa. International Journal of Eating Disorders. 2005;38(4):383-5. DOI: 10.1002/eat.20198
Burlaka I, Mityuryayeva I. Episode of renal dysfunction in a child with eating disorder: a case report. ScienceRise: Medical Science. 2024; 1 (58), 60–64. DOI:10.15587/2519-4798.2024.300710
Arora S, Bhargava A, Jasnosz K, Clark B. Relapsing acute kidney injury associated with pegfilgrastim. Case Reports in Nephrology and Dialysis. 2012 Nov 21;2(2):165-71. https://doi.org/10.1159/000345278
Khatri V, Bauschka M, Foley M, Lundberg C, Mehler P. A Multi-Disciplinary Approach to Managing End-Stage Renal Disease in Anorexia Nervosa: A Case Report. Clinical Medicine Insights: Case Reports. 2023 Apr;16:11795476231169385. DOI: 10.1177/11795476231169385
Kondo A, Yoshiya K, Sakakibara N, Nagano C, Horinouchi T, Nozu K. A case of pseudo-Bartter/Gitelman syndrome caused by long-term laxative abuse, leading to end-stage kidney disease. CEN Case Reports. 2024;13(5):326-9. DOI: 10.1007/s13730-024-00851-9
Puckett L. Renal and electrolyte complications in eating disorders: a comprehensive review. Journal of eating disorders. 2023 Feb 20;11(1):26. DOI: 10.1186/s40337-023-00751-w
Feidakis A, Panagiotou M-R, Tsoukakis E, Bacharaki D, Gounari P, Nikolopoulos P, et al. Impact of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers on acute kidney injury in emergency medical admissions. Journal of Clinical Medicine. 2021;10(3):412. DOI: 10.3390/jcm10030412
O’Callaghan C. Renal Disease; Fluid and Electrolyte Disorders. InMedicine for Finals and Beyond 2022 Jun 19 (pp. 277-330). CRC Press. DOI: 10.1201/9781003193616-8
Kim GH. Fluid and Electrolyte Problems in Chronic Kidney Disease. InManagement of Chronic Kidney Disease: A Clinician’s Guide 2023 Nov 25 (pp. 327-344). Cham: Springer International Publishing. DOI: 10.1007/978-3-031-42045-0_22
Friedman AN, Ogden CL, Hales CM. Prevalence of obesity and CKD among adults in the United States, 2017-2020. Kidney Medicine. 2023 Jan 1;5(1):100568. DOI: 10.1016/j.xkme.2022.100568
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