Kidney Week

Abstract: FR-PO0553

Lifestyle Interventions in Diabetic Kidney Disease: A Systematic Review Through Life's Essential 8 Lens

Session Information

• CKM: Clinical - Meta-Analyses, Predictive Modeling, Care Delivery, and Safety
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Cardiovascular-Kidney-Metabolic Health

• 602 Cardiovascular-Kidney-Metabolic Health: Clinical

Authors

• Almaraz Aguilar, Oscar David, The University of Texas Medical Branch at Galveston, Galveston, Texas, United States

Oscar David Almaraz Aguilar, MD, MPH

• Mark, Allyson G., The University of Texas Medical Branch at Galveston, Galveston, Texas, United States

Allyson G. Mark, MPH

• Alcocer Gonzalez Camarena, Paulina, The University of Texas Medical Branch at Galveston, Galveston, Texas, United States

Paulina Alcocer Gonzalez Camarena, MD/MPH

• Reyes, Giovanny, The University of Texas Medical Branch at Galveston, Galveston, Texas, United States

Giovanny Reyes

• Galan Trujillo, Valeria Beatriz, The University of Texas Medical Branch at Galveston, Galveston, Texas, United States

Valeria Beatriz Galan Trujillo, MD

• Villalbos, Andrea, The University of Texas Medical Branch at Galveston, Galveston, Texas, United States

Andrea Villalbos, MD

• Sallam, Hanaa, The University of Texas Medical Branch at Galveston, Galveston, Texas, United States

Hanaa Sallam, MD, PhD

• Serag, Hani, The University of Texas Medical Branch at Galveston, Galveston, Texas, United States

Hani Serag, MD, MPH

Background

Lifestyle interventions are essential in Type 2 Diabetes (T2D), but their efficacy in established diabetic kidney disease (DKD) remains heterogeneous. The American Heart Association's Life's Essential 8 (LE8) integrates health behaviors and factors that align with the Cardiovascular-Kidney-Metabolic syndrome. Whether current lifestyle interventions in DKD align with the LE8 framework remains unclear. We systematically evaluated whether the DKD lifestyle modification program interventions for patients with DKD align with LE8-defined cardiometabolic outcomes.

Methods

Following PRISMA guidelines, we searched SCOPUS, MEDLINE, and CENTRAL from January 2020 through January 2026 for randomized controlled trials (RCTs) of lifestyle interventions (diet, exercise, education, or self-management) in adults with T2D and DKD (defined by reduced eGFR and/or albuminuria). Pharmacological- only interventions and dialysis-dependent populations were excluded. Screening and data extraction were performed in duplicate using Covidence. An LE8 coverage matrix quantified outcome reporting. A narrative synthesis was performed due to clinical heterogeneity.

Results

Following the screening of 3780 studies, 18 RCTs (N=7,363) were included. Lifestyle interventions were reported to improve the following: 1) eGFR by 5.6%, 2) albuminuria by 30%, 3) LE8 Health Factors, including a) Hemoglobin A1c by 10%, b) Systolic blood pressure by 6%, c) Diastolic blood pressure by 4.3%, d) HDL by 4.3%, and e) BMI by 5%. LE8 Health behaviors, including nicotine exposure and sleep, were minimally or not reported.

Conclusion

Lifestyle interventions in DKD were associated with favorable trends in metabolic and renal outcomes. We recommend that future lifestyle RCTs in DKD include a comprehensive LE8 component assessment to standardize the evaluation of cardiovascular, kidney, and metabolic health