Abstract: PO2383
Can Structured, Moderate Exercise Slow Kidney Function Decline in Sedentary Elders?
Session Information
- CKD: Insights from Recent Clinical Trials and Large Real-World Effectiveness Studies
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Shlipak, Michael, University of California San Francisco, San Francisco, California, United States
- Hsu, Fang-Chi, Wake Forest University, Winston-Salem, North Carolina, United States
- Jotwani, Vasantha, University of California San Francisco, San Francisco, California, United States
- Tranah, Gregory J., California Pacific Medical Center, San Francisco, California, United States
- Fielding, Roger A., Tufts University, Medford, Massachusetts, United States
- Liu, Christine, Stanford University, Stanford, California, United States
- Ix, Joachim H., University of California San Diego, La Jolla, California, United States
- Coca, Steven G., Icahn School of Medicine at Mount Sinai, New York, New York, United States
Background
In numerous observational studies, higher physical activity is associated with slower declines in kidney function; however, no large trial has evaluated whether exercise can ameliorate kidney function decline in older adults. The Lifestyle Interventions and independence For Elders (LIFE) was a randomized clinical trial that demonstrated that a structured, moderate intensity physical activity (PA) intervention compared to a health education (HE) control intervention reduced the incidence of major disability among sedentary elders.
Methods
The LIFE-Kidney ancillary study evaluated whether this exercise intervention impacted the primary outcome of rate of eGFR change over two years. Participants were men and women aged 70-89 who reported being sedentary and were considered high risk for mobility impairment. Blood samples were collected pre-randomization (n=1,179), and at years 1 (n=1,155) and 2 (n=1,044) of follow-up; cystatin C was measured, and GFR was estimated by the CKD-EPI equation. Change in eGFR by cystatin C was the primary endpoint; rapid decline was defined by the high tertile threshold of 6.7%/year.
Results
At baseline, the two groups were well balanced by age, comorbidity and physical limitations, and had comparable eGFR. The PA group had eGFR values 0.5 and 1.5 ml/min/1.73m2 higher at years 1 and 2, respectively, and the average effect across the 2 follow-up visits was significantly different (p=0.04). Those in the PA arm were also less likely to experience a >6.7% annual eGFR decline compared to the HA arm (Table). In the PA arm, total steps completed was strongly associated with reduced eGFR decline (p=0.001), and mediated the effect of randomization to PA compared with HE (F statistic attenuated from 4.09 to 1.84).
Conclusion
Among sedentary elders, randomization to a program of moderate exercise slowed kidney function decline over 2 years compared with a control arm of health education.
| Physical Activity | Health Education Control | p-value | |
| Baseline eGFRcys | 54.0 | 53.4 | 0.52 |
| Year 1 eGFRcys | 52.6 | 52.1 | 0.33 |
| Year 2 eGFRcys | 51.5 | 50.0 | 0.02 |
| eGFR decline >6.7%/year over 2 years | 135 (25.9%) | 167 (32.2%) | 0.02 |
| Adusted* OR; 95% CI | 0.81; 0.66-0.99 | Ref. | 0.04 |
*Adjusted for baseline eGFR
Funding
- NIDDK Support