Abstract
BackgroundGuidelines recommend physical activity to reduce cardiovascular (CV) events. The association between physical activity and progression of chronic kidney disease (CKD) with and without diabetes is unknown. We assessed the association of self-reported physical activity with renal and CV outcomes in high-risk patients aged ≥ 55 years over a median follow-up of 56 months in post-hoc analysis of a previously randomized trial program.MethodsAnalyses were done with Cox regression analysis, mixed models for repeated measures, ANOVA and χ2-test. 31,312 patients, among them 19,664 with and 11,648 without diabetes were analyzed.ResultsPhysical activity was inversely associated with renal outcomes (doubling of creatinine, end-stage kidney disease (ESRD)) and CV outcomes (CV death, myocardial infarction, stroke, heart failure hospitalization). Moderate activity (at least 2 times/week to every day) was associated with lower risk of renal outcomes and lower incidence of new albuminuria (p < 0.0001 for both) compared to lower exercise levels. Similar results were observed for those with and without diabetes without interaction for renal outcomes (p = 0.097–0.27). Physical activity was associated with reduced eGFR decline with a moderate association between activity and diabetes status (p = 0.05).ConclusionsModerate physical activity was associated with improved kidney outcomes with a threshold at two sessions per week. The association of physical activity with renal outcomes did not meaningfully differ with or without diabetes but absolute benefit of activity was even greater in people with diabetes. Thus, risks were similar between those with diabetes undertaking high physical activity and those without diabetes but low physical activity.Clinical trial registration: http://clinicaltrials.gov.uniqueidentifier:NCT00153101.
Highlights
Guidelines recommend physical activity to reduce cardiovascular (CV) events
As there were no differences of Description of physical activity In the clinical research file (CRF), participants indicated their usual level of physical activity according to five activity levels at the randomization visit
Recruitment for ONTARGET took place between December 1, 2001 and July 31, 2003; and for TRANSCEND between November 1, 2001 and May 30, 2004; 31,546 patients were randomized from 737 centers in 40 countries and followed-up for a median of 56 months
Summary
Guidelines recommend physical activity to reduce cardiovascular (CV) events. The association between physical activity and progression of chronic kidney disease (CKD) with and without diabetes is unknown. Renal outcomes were key secondary endpoints in The Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial (ONTARGET) [15] and the Telmisartan Randomised AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease (TRANSCEND) [16] trials which randomized high risk CV patients to ramipril, telmisartan or both of these drugs with neutral CV results in all treatment strata [15,16,17] As this trial program recorded self-reported exercise at enrollment and adjudicated rigorously endpoints, it represents a unique database to investigate the associations of physical activity with renal outcomes in 31,312 patients with approximately a third with a history of diabetes. The treatment groups were pooled and analyzed together in this post-hoc analysis
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