Healthy lifestyle lowers chronic kidney disease and mortality in type 2 diabetes

In the population with type 2 diabetes, even modest changes in lifestyle and dietary risk factors could have a substantial effect on chronic kidney disease (CKD) cases and deaths, suggests a study in The American Journal of Kidney Diseases.

The researchers analyzed the population-attributable fraction (PAF) of diabetes-related CKD and mortality associated with lifestyle factors and diet. The study included 6916 middle-aged adults with type 2 diabetes but without severe albuminuria drawn from the international Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial Study. Median baseline urinary albumin-to-creatinine ratio was 6.6, and eGFR was 71.5 mL/min per 1.73 m2.

The effects of “immediately modifiable personal behaviors” on CKD risk were analyzed using 5.5-year follow-up data. CKD was defined as moderate to severe albuminuria or at least a 5% annual decline in eGFR. The analysis accounted for competing risk of death.

During follow-up, 32.5% of patients developed albuminuria, 55.2% had a 5% or greater decline in eGFR, 12.3% met both CKD criteria, and 14.8% died. Daily physical activity was associated with reduced risk of both outcomes: PAF of 5.1% for CKD and 12.3% for death. Dietary improvements also had a significant effect—particularly increased consumption of vegetables.

Less than optimal diet, body weight, physical activity, tobacco use, and size of social network were associated with PAFs of 13.3% for CKD and 37.5% for death. Extrapolated to the US population of 17.8 million middle-aged adults with diabetes over 5.5 years, the findings suggested that achieving one modifiable lifestyle factor could reduce CKD incidence/progression by 274,0000 and avoid 405,000 deaths.

Unfavorable dietary and lifestyle factors seem to be major contributors to the risk of CKD events and death among middle-aged Americans with type 2 diabetes. Although some of the PAFs reported in this study are not large, the results suggest that healthier diet and lifestyle changes could have a “substantial impact on population kidney health” [Dunkler D, et al. Population-attributable fractions of modifiable lifestyle factors for CKD and mortality in individuals with type 2 diabetes: A cohort study. Am J Kidney Dis 2016; 68:29–40].