Lifestyle Interventions, Kidney Disease Progression, and Quality of Life: A Systematic Review and Meta-analysis

RATIONALE & OBJECTIVE: Poor dietary patterns and low physical activity levels are important lifestyle-related factors that contribute to negative health outcomes in individuals with chronic kidney disease (CKD). Previous systematic reviews have not explicitly focused on these lifestyle factors, nor undertaken meta-analyses of any effects. We aimed to evaluate the effect of lifestyle interventions (such as diet, exercise, and other lifestyle-related interventions) on the risk factors for and progression of CKD and the quality of life. STUDY DESIGN: Systematic review and meta-analysis SETTING & STUDY POPULATIONS: Individuals aged 16 years or older with CKD stages 1 to 5 not requiring kidney replacement therapy. SELECTION CRITERIA FOR STUDIES: Randomized controlled trials of interventions. DATA EXTRACTION: Kidney function, albuminuria, creatinine, systolic blood pressure, diastolic blood pressure, body weight, glucose control, and quality of life. ANALYTICAL APPROACH: A random-effects meta-analysis with evidence certainty assessed using GRADE. RESULTS: Seventy-eight records describing 68 studies were included. Twenty-four studies (35%) were dietary interventions, 23 (34%) exercise, 9 (13%) behavioral, 1 (2%) hydration, and 11 (16%) multiple component. Lifestyle interventions resulted in significant improvements in creatinine (weighted mean difference [WMD], −0.43 mg/dL; 95% CI, −0.74 to −0.11; P = 0.008); 24-hour albuminuria (WMD, −53 mg/24 h; 95% CI, −56 to −50; P < 0.001); systolic blood pressure (WMD, −4.5 mm Hg; 95% CI, −6.7 to −2.4; P < 0.001); diastolic blood pressure (WMD, −2.2 mm Hg; 95% CI, −3.7 to −0.8; P = 0.003); and body weight (WMD, −1.1 kg; 95% CI, −2.0 to −0.1; P = 0.025). Lifestyle interventions did not result in significant changes in the estimated glomerular filtration rate (0.9 mL/min/1.73 m(2); 95% CI, −0.6 to 2.3; P = 0.251). However, narrative synthesis indicated that lifestyle intervention resulted in improvements in the quality of life. LIMITATIONS: Certainty of the evidence was rated very low for most outcomes, primarily owing to the risk of bias and inconsistency. No meta-analysis was possible for quality-of-life outcomes because of variations in measurement tools. CONCLUSIONS: Lifestyle interventions seem to positively affect some risk factors for progression of CKD and quality of life.