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The 10-Year Effects of Intensive Lifestyle Intervention on Kidney Outcomes
Linda-Marie U Lavenburg1, Douglas E Schaubel2, Ariana M Chao3
1Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, PA.
Rationale & Objective:
Limited data exist on longitudinal kidney outcomes after nonsurgical obesity treatments. We investigated the effects of intensive lifestyle intervention on kidney function over 10 years.
Study Design:
Post hoc analysis of Action for Health in Diabetes (Look AHEAD) randomized controlled trial.
Setting & Participants:
We studied 4,901 individuals with type 2 diabetes and body mass index of ≥25 kg/m2 enrolled in Look AHEAD (2001-2015). The original Look AHEAD trial excluded individuals with 4+ urine dipstick protein, serum creatinine level of >1.4 mg/dL (women), 1.5 mg/dL (men), or dialysis dependence.
Exposures:
Intensive lifestyle intervention versus diabetes support and education (ie, usual care).
Outcome:
Primary outcome was estimated glomerular filtration rate (eGFR, mL/min/1.73 m2) slope. Secondary outcomes were mean eGFR, slope, and mean urine albumin to creatinine ratio (UACR, mg/mg).
Analytical Approach:
Linear mixed-effects models with random slopes and intercepts to evaluate the association between randomization arms and within-individual repeated measures of eGFR and UACR. We tested for effect modification by baseline eGFR.
Results:
At baseline, mean eGFR was 89, and 83% had a normal UACR. Over 10 years, there was no difference in eGFR slope (+0.064 per year; 95% CI: -0.036 to 0.16; P = 0.21) between arms. Slope or mean UACR did not differ between arms. Baseline eGFR, categorized as eGFR of <80, 80-100, or >100, did not modify the intervention's effect on eGFR slope or mean.
Limitations:
Loss of muscle may confound creatinine-based eGFR.
Conclusions:
In patients with type 2 diabetes and preserved kidney function, intensive lifestyle intervention did not change eGFR slope over 10 years. Among participants with baseline eGFR <80, lifestyle intervention had a slightly higher longitudinal mean eGFR than usual care. Further studies evaluating the effects of intensive lifestyle intervention in people with kidney disease are needed.
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