An intensive lifestyle intervention had no effect on kidney function in patients with type 2 diabetes relative to usual care consisting of diabetes support and education, according to data presented at the American Society of Nephrology’s Kidney Week 2022 conference in Orlando, Florida.
Based on a post-hoc analysis of 4901 patients who participated in the Look AHEAD (Action for Health in Diabetes) study, Linda-Marie Lavenburg, DO, MSCE, of the University of Pittsburgh in Pennsylvania, and colleagues found that a lifestyle intervention consisting of 14 or more behavioral weight loss counseling sessions over 6 months did not significantly change the slope of estimated glomerular filtration rate (eGFR) or mean urine albumin to creatinine ratio (UACR) compared with usual care over 10 years. Among patients with an eGFR less than 80 mL/min/1.73 m2, however, patients assigned to the intervention group had a slightly higher mean eGFR than those in the usual care group.
Look AHEAD was conducted from June 2001 to June 30, 2020. It evaluated whether intentional weight loss decreases cardiovascular morbidity and mortality among overweight patients with type 2 diabetes. The study enrolled 5145 participants randomly assigned to an intensive lifestyle intervention or usual care. The lifestyle intervention was designed to facilitate lower calorie intake, more physical activity, and weight loss maintenance. The physical activity goal was 175 minutes or more per week of moderately intense activity achieved by month 6. Investigators instructed participants to engage in brisk walking or similar aerobic activity.
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The patients included in the post-hoc analysis ranged in age from 45 to 76 years (mean age 59 years) and had a body mass index of 25 kg/m2 or higher. At baseline, patients had a mean eGFR of 89 mL/min/1.73 m2 and a mean UACR of 0.043 mg/mg.
In an interview with Renal & Urology News, Dr Lavenburg offered potential explanations for why the lifestyle intervention might not have affected kidney function. The use of creatinine as a surrogate marker for kidney function is imperfect, particularly when used in weight loss studies, because it is affected by changes in muscle mass and dietary protein, she said. The usual care group continued to lose some weight over 10 years, but their weight loss was predominantly muscle mass, suggesting non-intentional weight loss. The between-group difference in the slope of creatinine-based eGFR may be minimized because of confounding by muscle mass in the usual care group: less muscle and lower creatinine generation would have led to overestimation of eGFR.
In a general population, Dr Lavenburg pointed out, the reported change in eGFR among individuals over age 40 years is small (approximately 1 mL/min/1.73m2 per year). “So, if there were a benefit from the intervention, the difference in slope of eGFR between groups was expected to be fractional,” she said. “Perhaps we need more time to see differences, especially when studying a group with generally good kidney function and mostly normal albuminuria. I believe studying the effects of lifestyle interventions in persons with CKD and some albuminuria would be valuable and may tell a different story. But again, the measure or estimator of kidney function would need to be carefully chosen.”
Reference
Lavenburg LM, Schaubel D, Reese P, Cohen J. Investigating the 10-year effects of intensive lifestyle intervention on kidney outcomes. Presented at: Kidney Week 2022; November 3-6, Orlando, Florida. Abstract TH-PO849.
