Lifestyle Interventions, Kidney Disease Progression, and Quality of Life: A Systematic Review and Meta-analysis

Abstract

Poor dietary patterns and low physical activity levels are important lifestyle-related factors that contribute to negative health outcomes in individuals with chronic kidney disease (CKD). Previous systematic reviews have not explicitly focused on these lifestyle factors, nor undertaken meta-analyses of any effects. We aimed to evaluate the effect of lifestyle interventions (such as diet, exercise, and other lifestyle-related interventions) on the risk factors for and progression of CKD and the quality of life. Systematic review and meta-analysis. Individuals aged 16 years or older with CKD stages 1 to 5 not requiring kidney replacement therapy. Randomized controlled trials of interventions. Kidney function, albuminuria, creatinine, systolic blood pressure, diastolic blood pressure, body weight, glucose control, and quality of life. A random-effects meta-analysis with evidence certainty assessed using GRADE. Seventy-eight records describing 68 studies were included. Twenty-four studies (35%) were dietary interventions, 23 (34%) exercise, 9 (13%) behavioral, 1 (2%) hydration, and 11 (16%) multiple component. Lifestyle interventions resulted in significant improvements in creatinine (weighted mean difference [WMD],-0.43mg/dL; 95% CI,-0.74 to-0.11; P=0.008); 24-hour albuminuria (WMD,-53mg/24h; 95% CI,-56 to-50; P<0.001); systolic blood pressure (WMD,-4.5mm Hg; 95% CI,-6.7 to-2.4; P<0.001); diastolic blood pressure (WMD,-2.2mm Hg; 95% CI,-3.7 to-0.8; P=0.003); and body weight (WMD,-1.1kg; 95% CI,-2.0 to-0.1; P=0.025). Lifestyle interventions did not result in significant changes in the estimated glomerular filtration rate (0.9mL/min/1.73m2; 95% CI,-0.6 to 2.3; P=0.251). However, narrative synthesis indicated that lifestyle intervention resulted in improvements in the quality of life. Certainty of the evidence was rated very low for most outcomes, primarily owing to the risk of bias and inconsistency. No meta-analysis was possible for quality-of-life outcomes because of variations in measurement tools. Lifestyle interventions seem to positively affect some risk factors for progression of CKD and quality of life.