Lifestyle intervention shows kidney benefits in diabetic patients

By Nikki Withers, medwireNews Reporter

A lifestyle intervention focused on weight loss and increasing physical activity should be considered as additional treatment to prevent advanced kidney disease in overweight or obese people with Type 2 diabetes, say researchers.

The team found that an intensive lifestyle intervention (ILI) reduced the incidence of very-high-risk chronic kidney disease (CKD) in these patients by 31% compared with those who received diabetes support and education (DSE).

Weight loss should therefore be considered as an adjunct to medical treatment to prevent or delay progression of CKD in overweight or obese people with Type 2 diabetes, write Judy Bahnson (Wake Forest School of Medicine, North Carolina, USA) and colleagues in TheLancet Diabetes and Endocrinology.

In total, 4831 participants from the Look AHEAD (Action for Health in Diabetes) trial were included in the present analysis. All were aged between 45 and 76 years, were overweight or obese and were able to complete a maximal exercise test.

Participants randomly assigned to participate in the ILI group aimed to achieve and maintain weight loss of at least 7% through reduced calorific intake and increased physical activity. During a median follow-up of 8 years, the incidence of very-high-risk CKD was significantly lower in patients who received ILI than those who received DSE (0.63 vs 0.91 cases per 100 patient–years), which focused on diet, exercise and social support.

Very-high-risk CKD was defined as an estimated glomerular filtration rate (eGFR) of less than 30 mL/min per 1.73m² regardless of albumin:creatinine ratio (ACR), eGFR below 45mL/min per 1.73m² plus ACR of at least 30 mg/g, or eGFR less than 60mL/min per 1.73m² plus urine ACR greater than 300 mg/g.

The effect of ILI was greatest in women and those with a baseline body mass index less than 35 kg/m², and was partially attributable to reductions in bodyweight, glycated haemoglobin and systolic blood pressure, says the team.

However, in an accompanying commentary, Dick de Zeeuw and Hiddo Lambers Heerspink, from the University Medical Center Groningen in the Netherlands, warn that the results of the present study should be taken with caution, given that the primary result of the trial – the effect on major cardiovascular events – was negative.

“The authors’ conclusion that lifestyle intervention protects the kidney is […] difficult to reconcile with the surprising finding that weight reduction does not provide cardiovascular protection”, they say.

“Data on urinary sodium or urea, or both, would be helpful to resolve why the intervention did not affect cardiovascular outcomes yet did protect the kidneys.”

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