Exercise intensity and the risk of end-stage renal disease in diabetes: A nationwide population-based study

Exercise plays a key role in managing chronic conditions such as diabetes mellitus (DM), a major contributor to end-stage renal disease (ESRD), a serious public health issue.

To investigate the relationship between exercise intensity, DM duration, and ESRD incidence.

This retrospective cohort study analyzed data from 2495031 individuals with DM who underwent the Korean National Health Screening between 2015 and 2016, with follow-up through 2022. The Cox proportional hazards model was adjusted for confounders, including age, sex, income, smoking, and baseline comorbidities.

Longer DM duration was associated with a significantly higher risk of ESRD, with durations ≥ 10 years showing the highest risk [hazard ratio (HR): 2.624, 95% confidence interval (CI): 2.486-2.770]. Increased exercise intensity reduced the risk of developing ESRD across all diabetes duration groups, with the highest exercise category (≥ 1500 metabolic equivalents of task-min/week) demonstrating a protective effect compared to that of no exercise (HR: 0.837, 95%CI: 0.791-0.886). Exercise benefits were more pronounced in patients without hypertension, non-smokers, and those with lower alcohol consumption. Additionally, ESRD risk reduction was significant among patients with a body mass index ≥ 25 and those without proteinuria or chronic kidney disease.

Longer diabetes duration is associated with increased ESRD risk, while high-intensity exercise may mitigate this risk. These findings suggest promoting exercise is important for managing diabetes to reduce renal complications.