Effects of physical activity on the progression of diabetic nephropathy: a meta-analysis

Abstract

Background: Diabetic nephropathy (DN) is an important microvascular complication of diabetes. Physical activity (PA) is part of a healthy lifestyle for diabetic patients; however, the role of PA in DN has not been clarified. Our aim was to conduct a meta-analysis to explore the association between PA and DN risk. Methods: PubMed, Embase, Cochrane Library and Web of Science were systematically searched for articles examining PA in diabetic patients and its effect on renal function. Standardized mean differences (SMDs) and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. The study protocol is registered with PROSPERO (CRD42020191379). Results: A total of 38991 participants were identified from 18 studies. The results indicated that PA was associated with increases in the glomerular filtration rate (SMD = 0.01, 95% CI = [0.02–0.17]) and decreases in the urinary albumin creatinine ratio (SMD = −0.53, 95% CI: −0.72 to −0.34), rate of microalbuminuria (OR = 0.61, 95% CI = [0.46–0.81]), rate of acute kidney injury (OR = 0.02, 95% CI = [0.01–0.04]), rate of renal failure (OR = 0.71, 95% CI = [0.52–0.97]) and risk of DN in patients with Type 1 diabetes (OR = 0.67, 95% CI = [0.51–0.89]). Conclusions: This meta-analysis indicated that PA is effective for improving DN and slowing its progression; however, more high-quality randomized controlled trials are required on this topic.

Effect of exercise on renal function in diabetic nephropathy—a systematic review and meta-analysis

“…A recent meta-analysis of 14 non-RCTs and four RCTs has examined the protective effects of physical activity on DN progression and reported similar results. 38 With exercise, GFR increases (SMD = 0.9; 95% CI 0.02 to 0.17), UACR decreases (SMD = −0.53; 95% CI -0.72 to −0.34), the rate of microalbuminuria decreases (OR = 0.61; 95% CI 0.46 to 0.81), and serum creatinine levels do not change (SMD = −0.02; 95% CI −0.09 to 0.06), according to a prior study. 38 Zhang et al.…”

Effects of Home-Based Exercise Training on Cardiac Autonomic Neuropathy and Metabolic Profile in Diabetic Hemodialysis Patients

“…Since CAN is closely related to reduced work tolerance and inappropriate heart rate, blood pressure and cardiac output in response to exercise, patients with increased CAN are having difficulties in performing their daily activities. On the other hand, increased physical activity is highly recommended for these populations [ 7 , 8 , 9 , 10 ], to ameliorate the CV burden by increasing heart rate variability (HRV) and improving left ventricular (LV) function (especially for heart patients) [ 11 , 12 ]. Pathophysiological mechanisms of exercise on cardiac autonomic function, functional capacity, lipid, and glucose profile in DKD patients are shown in Figure 1 .…”

Resistance Training Improved the Kidney Function of Type 2 Diabetic Patients with the Risk of Nephropathy: A Randomized Control Trial

“…Nevertheless, in addition to early detection, proper intervention is also vitally necessary to control further deterioration in the kidney function of diabetic patients. Numerous studies have shown that physical activity and exercise, as a non-pharmacological treatment for a healthy lifestyle, are significantly effective in DN improvement and slowing its progression in T2D patients (18,19). Physical activity is associated with increased eGFR, decreased urinary albumin creatinine ratio (UACR), and decreased rate of microalbuminuria in diabetics (18,19).…”

“…Numerous studies have shown that physical activity and exercise, as a non-pharmacological treatment for a healthy lifestyle, are significantly effective in DN improvement and slowing its progression in T2D patients (18,19). Physical activity is associated with increased eGFR, decreased urinary albumin creatinine ratio (UACR), and decreased rate of microalbuminuria in diabetics (18,19). Nevertheless, the type of exercise is highly important.…”

“…All these factors are the major determinant mechanisms of T2D (23). Besides, since the muscular system accounts for 35 to 40% of body weight and approximately 75% of whole-body insulin-stimulated glucose uptake (24), RT, which is much more involved with the muscular system, may delay or ameliorate the development of T2D complications, such as nephropathy (3,19,20,23).…”