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Increased physical activity reduced chronic kidney disease in patients with type 2 diabetes
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CHICAGO — Patients with type 2 diabetes who increase their physical fitness efforts can reduce their risk for developing chronic kidney disease, or improve kidney function if they already have damage, according to research presented at the joint meeting of the International Congress of Endocrinology and the Endocrine Society.
“In this population with high comorbidities and medication use, an enhanced fitness level or a minimal amount of exercise exposure provided important renal benefits,” Shruti Mahendra Gandhi, MD, of the VA Medical Center in Washington D.C. and George Washington University School of Medicine and Health Sciences, said during her presentation.
Fitness and CKD
Gandhi and colleagues studied 2,007 patients with type 2 diabetes (mean age, 61±10.3 years) with normal kidney function who had completed an exercise stress test. The researchers were looking to assess the relationship between exercise and mortality in chronic kidney disease (CKD).
Using a Cox proportional hazard model, the investigators determined the MET level that was not associated with increased risk of progression to CKD (7.5 METs; HR=1). From this level, fitness categories for the patients were created: Least-Fit (<5.5 METs); Low-Fit (5.5-7.5 METs); Moderate-Fit (7.6-9.5 METs); and High-Fit (>9.5 METs).
Risk of progression to CKD or death was assessed, with adjustments for age, BMI, cardiac risk factors, sleep apnea, alcohol dependence and cardiac medications.
Outcomes for CKD (mean follow up=7.3±5.1 years) showed combined events (CKD/death) were 572 (39 deaths/1,000 person-years). Mortality risk and rate of advancement to CKD decreased progressively as fitness increased.
By fitness category, the rate of progression to CKD was lower by 41% (HR=0.59; P<.001) for Low-Fit patients; 51% (HR=0.49; P<.001) for the Moderate-Fit patients; and 68% (HR=0.32; P<.001) for High-Fit patients.
“There was also a precipitous drop when you compare the least-fit to low-fit,” Gandhi said. “This actually tells us that even a small amount of exercise can decrease the risk of progression.”
Exercise and eGFR
Researchers also sought to evaluate the effect that an exercise program would have on epidermal growth factor receptor (eGFR). In this study, researchers assessed a group of 128 patients with type 2 diabetes who completed a 12-week aerobic/resistance supervised exercise program. Peak exercise capacity (in METs), metabolic panel and blood pressure were measured at baseline and completion. Patients were grouped by baseline eGFR >60 mL/min/1.73m2 and eGFR 30-60 mL/min/1.73m2; a paired samples t-test was used to compare the impact of exercise between the two groups.
Through the exercise program, significant improvements were seen in METs (P<.001), HbA1c (P=.009) and plasma glucose levels (P=.032) for the group with eGFR>60 mL/min/1.73m2. There were no significant changes in eGFR in this group.
Significant improvements were seen at baseline and study conclusion, respectively, in exercise capacity (7.22±1.85 METs vs 8.56±2.3 METs; P=.042) and eGFR (53.0±4.2 vs 61.5±9.9; P=.002) for the group with eGFR 30-60 mL/min/1.73m2.
“This suggests that increased cardiorespiratory fitness is an important non-pharmacologic adjunct to treatment of kidney dysfunction,” Gandhi said. “It’s possible that additional sessions, increased duration or alternative exercise strategies may augment these findings.” — by Allegra Tiver
For More Information: Gandhi SM. Abstract OR40-1. Presented at: The joint meeting of the International Congress of Endocrinology and the Endocrine Society; June 21-24, 2014; Chicago.
Disclosures: Gandhi reports no relevant disclosures.