Background: Guidelines recommend physical activity to reduce cardiovascular (CV) events. The association between
physical activity and progression of chronic kidney disease (CKD) with and without diabetes is unknown. We assessed
the association of self-reported physical activity with renal and CV outcomes in high-risk patients aged≥55 years over
a median follow-up of 56 months in post-hoc analysis of a previously randomized trial program.
Methods: Analyses were done with Cox regression analysis, mixed models for repeated measures, ANOVA and χ2
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test. 31,312 patients, among them 19,664 with and 11,648 without diabetes were analyzed.
Results: Physical activity was inversely associated with renal outcomes (doubling of creatinine, end-stage kidney
disease (ESRD)) and CV outcomes (CV death, myocardial infarction, stroke, heart failure hospitalization). Moderate
activity (at least 2 times/week to every day) was associated with lower risk of renal outcomes and lower incidence of
new albuminuria (p<0.0001 for both) compared to lower exercise levels. Similar results were observed for those with
and without diabetes without interaction for renal outcomes (p=0.097–0.27). Physical activity was associated with
reduced eGFR decline with a moderate association between activity and diabetes status (p=0.05).
Conclusions: Moderate physical activity was associated with improved kidney outcomes with a threshold at two
sessions per week. The association of physical activity with renal outcomes did not meaningfully difer with or without
diabetes but absolute beneft of activity was even greater in people with diabetes. Thus, risks were similar between
those with diabetes undertaking high physical activity and those without diabetes but low physical activity.
Clinical trial registration: http://clinicaltrials.gov.uniqueidentifer:NCT00153101