OR40-1 Fitness Impact on Renal Function and Chronic Kidney Disease in Type 2 Diabetics

Program: Abstracts - Orals, Poster Preview Presentations, and Posters
Session: OR40-Type 2 Diabetes: Beta Cell Function and Novel Interventions
Monday, June 23, 2014: 11:30 AM-1:00 PM
Presentation Start Time: 11:30 AM
W185 (McCormick Place West Building)
Shruti Mahendra Gandhi, MD1, Peter Kokkinos, PhD, FAHA, FACSM2, Lauren Korshak, MS2, Joseph Powell, PA-C2 and Eric S Nylen, MD2
1VA Medical Center, Washington DC and George Washington University School of Medicine and Health Sciences, 2VA Medical Center, Washington, D.C.
Introduction:  Diabetes is the most common cause of end-stage kidney disease. Fitness status and increased physical activity are essential for diabetic health. Their impact, however, on CKD outcomes and renal function have not been extensively investigated.

Objectives:  The primary objective was to assess the exercise capacity-progression to CKD- mortality association. A secondary objective was to assess the effect of a 12-week exercise program on eGFR. 

Methods: We identified 2,007 type 2 diabetics (mean age: 61±10.3 years) with normal kidney function who completed an exercise stress test at the VA Medical Center, Washington, DC. Cox proportional hazard model with spline function of MET was used to define the MET level associated without increased risk of progression to CKD (HR=1.0). This MET level (7.5 METs) was used to form four fitness categories based on intervals of 2 METs above and below this threshold: Least-Fit (<5.5 METs); Low-Fit (5.5-7.5 METs) Moderate-Fit (7.6-9.5 METs) and High-Fit (>9.5 METs). Cox proportional hazard analysis, adjusted for age, BMI, cardiac risk factors, sleep apnea, alcohol dependence and cardiac medications, was used to assess the risk of progression to CKD or death. The Least-Fit category was used as the referent.

We also assessed the effects of exercise on renal function in 67 type 2 diabetics. All completed a 12-week aerobic/resistance supervised exercise program. Peak exercise capacity (METs) metabolic panel and blood pressure were evaluated at baseline and after the completion of the program. Patients were classified into 2 groups based on baseline eGFR >60 mL/min/1.73m2 (n=52) and eGFR 30-60 mL/min/1.73m2 (n=15). The effect of exercise was compared within groups using a paired samples t-test.

Results: In the CKD outcomes cohort (mean f/u=7.3 ±5.1 years), the combined events (CKD/death) were 572 (39 deaths/1000 person-years). The mortality risk and rate of progression to CKD were progressively lower with increased fitness. More specifically, the rate was lower by 41% (HR=0.59; CI: 0.49-0.72; p<0.001) for Low-Fit; 51% (HR=0.49; CI: 0.372-0.633; p<0.001) for the Moderate-Fit and 68% (HR=0.32; CI: 0.172-0.6; p<0.001) for High-Fit individuals.

No significant change in eGFR was noted for the group with eGFR>60 mL/min/1.73m2 despite significant improvement in METs (p<0.001), HbA1c (p=0.009) and plasma glucose level (p=0.032).  However, patients with eGFR 30-60 mL/min/1.73m2 had significant improvement in both exercise capacity (7.22±1.85 METs vs 8.56±2.3 METs, p=0.042) and eGFR (53.0±4.2 vs 61.5±9.9; p=0.002) at baseline and post intervention, respectively.

Conclusions: Exercise capacity amongst diabetics was inversely associated with the rate of progression to CKD and mortality. In addition, renal function improved in CKD Stage 3 diabetics following the exercise program with 53% patients improving to CKD Stage 2.

Nothing to Disclose: SMG, PK, LK, JP, ESN

*Please take note of The Endocrine Society's News Embargo Policy at https://www.endocrine.org/news-room/endo-annual-meeting

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